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i ' r <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> - ----- -- -- - _ <br /> - -To: San-Joaquin County-.- - - - JOB#- - 7 s REF.# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE <br /> VALID DRIVEWAYS: <br /> Pacific Gas & Electric STREET _►� nefi <br /> AREA TlhornQUAD /V <br /> P.O. BOX 930 TYPE RP(( <br /> STOCKTON, CA 95201 FORMS _gf/WW R2!1 <br /> 209-942-1627 NOTES _ <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM ;3' ,P9 T90 t�l <br /> Notif. <br /> The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right o-Waayyyoon <br /> the o side of W- Oe. 1—(8' feet/r4- I,�Jii n <br /> of 6a-z rn,nr,P.,+r orf)+L r1 _,by performing the following work(description of work): <br /> CAVA ' ' -}o ff I a5 �2fV l� tb a- no rest�IerY.e Qf <br /> S�11 W Fir1e 51- <br /> Work will commence on or about !v _for approximately 197c> days. <br /> I,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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 1112 <br /> awu <br /> Signature of Applicant-Title Date <br /> E:N KIMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC (0110B) <br /> Return Permit;to: <br /> CCD <br /> P.O. Box 931) <br /> Stockton, CA 952111-0930 <br />