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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: - . .San Joaquin County -JOB# 7300 S 2 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 10-3t- 1 ¢ <br /> VALID g Z 2 - 11 TO 1()- t DRIVEWAYS: <br /> Pacific Gas & Electric STREET _ggdlA <br /> P.O. BOX 930 AREA QUAD <br /> TYPE or.( 'l to <br /> STOCKTON, CA 95201 FORMS ^S S 1�✓I�/ R <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> Notif. <br /> The undersigned hereby applies for p rmission to excavate, construct and/or otherwise encroach on County Highway Right-gQf-Way on <br /> theside of approximatelyL� feet/maf�*��71 <br /> of Ave,ftby performing the follo ing work(description of work): <br /> Work will commence on or about for approximately 410 days. <br /> I,the undersigned,certify that I am the owner of the respective property,or ani 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 /> • ' a � - Y <br /> OIL 1147: <br /> Signature of Applicant-Title bate <br /> EiP . MMASTER.PSIENCROACHMENT PERMIT APPLICATICN.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />