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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �j_ �?� 14— OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 U 0 Z REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ( - <br /> VALID -f S-(¢ TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET 43cif <br /> P.O. BOX 930 AREA 7YAC� QUAD ^5 <br /> TYPE lin <br /> STOCKTON, CA 95201 FORMS 55 WW Z� <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traff is Control Plan <br /> s hal I be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM i5loq44409 <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Xe side of CMA-;- Ad- approximately 132 feeVxAe W/0 <br /> of L 4ryl& • A.G by performing the following work(description of work): <br /> LAvA ( A5) <br /> M P pf- VGurGL• <br /> Work will commence on or about f}//Z 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 /> r <br /> 4/1 z4 14 <br /> E:IPLSignature of Applicant-Title Date <br /> IMASTERRSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />