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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To; San Joaquin:County JOB# (J(J5 2 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Q -3 (- <br /> VALIDTO (0-3(-14- DRIVEWAYS: <br /> Pacific Gas & Electric STREET _( ,-,iicetm 400 <br /> P.O. BOX 930 AREA TYPE 5.� - QU D C <br /> kuhole <br /> STOCKTON, CA 95201 FORMS SS/l.✓ ,,Z g29 390 <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 a ��-' <br /> California supplement <br /> I�I �''I <br /> Notif. <br /> The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the o side of ''111C�,�fl �✓e approximately 115 ' feeVvft C� <br /> of t-Unry— Ave �VIor1 by performing the following work(description of work): <br /> tpyrV— <br /> Work will commence on or about for approximately D 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 /> 4A() \136D ft�u - /7(. 6 01-41 h 4- <br /> E:N(ISignature of Applicant-Title D to <br /> NASTEP P&ENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />