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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 'q/< 111 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7300 52 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE, <br /> VALID ,; -ZZ- TO DRIVEWAYS: <br /> Pacific Gas & Electric STRE1 1 <br /> P.O. BOX 93O AREA Lnrn QUAD <br /> 41 W <br /> TYPE F,Q ll A,)le <br /> STOC KTON, CA 95201 FORMS s S 2 2- <br /> 209-942-1627 <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 !t)toq ql4o California supplement <br /> Notif. <br /> The undersigned hereby applies for permission to xcavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of -radar R approximately 4d' JI feethm#e laGt-�k <br /> of �T d.i. by performing the following work(description of work): <br /> 64�JQ At> Ci l— nAA..-) <br /> 55 5 177A&46r L.. <br /> Work will commence on or about for approximately G(o 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 /> oawu ' 17r. , lv�� 1A L][[- <br /> Signature of Applicant-Title Date <br /> J <br /> KIMASTER.PSIENGROACRMENTPERMITAPPLICATION.DOC (01/0) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />