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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��2� , OFFICE USE ONLY <br /> To: San Joaquin County JOB# P-73ZX5Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ( l–zal <br /> VALID '7–leim.tot 0 –1 – ,o 17 DRIVEWAYS: <br /> Pacific Gas & Electric STREET lEl <br /> P.O. BOX 930 AREA Kr1 V--Qt C, <br /> TYPE 1 r wC. <br /> STOCKTON, CA 95201 FORMS Tvltc <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 /> PM <br /> California supplement <br /> ��o��Gl�� <br /> Notif. <br /> The unders' ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the _" side of I;AMw47� approximately =7 feetEmk ked <br /> of ranl-lan , 6+P40 , by performing the following work(description of work): <br /> Work will commence on or about ZA 14 —for approximately 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 /> LUSignature of Applicant-Title Date <br /> E]PHIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (OWB( <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />