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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7-1, , OFFICE USE ONLY <br /> - <br /> Jo:_ San Joaquin County _ -:_- JOB.# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE <br /> Pacific Gas a.nd Electrlc ®, VALID _`]-I,�_ ., TO -�?.e�� DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA �I UAD NW <br /> TYPES <br /> Stockton, CA 95201 _ zi'j" �Cb <br /> FORMS ,, ,���2q <br /> NOTES <br /> 6�0q) 9A-2 ' 1 4-Z <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> - 1 <br /> Traffic Control Plan <br /> See attached sketch. ;, Shall be as per <br /> PMcurrent M.U.T.C.D. <br /> iVotif.IC -��-�J. California supplement. <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br /> .The undersigned hereby applies for permission to e�ccavate,construct and/or otherwise encroach on County Highway Right-of W y on <br /> the 50 side of—.. N \%f= , approximately X07 feet <br /> performin the f Ilowing work de cription of work): <br /> C <br /> Work will commence on or about ` -—Jor approximately days. <br /> f,the undersigned,certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work ( d above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> Signature of Ap icant-Title Date <br /> E•NUB-SV.WIM4ASTER.PSIENCROACFWENTPERMTAPPLICATION.DOC(01109J <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />