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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date l OFFICE USE ONLY <br /> _ To: San Joaquin,County JOB# 7300 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE (2 -3(-1 I- <br /> VALID TO — ( - _ DRIVEWAYS: <br /> Pacific Gas & Electric STREET TW0 (f <br /> P.O. BOX 930 AREA QUAD <br /> TYPE <br /> STOCKTON, CA 95201 FORMS <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 /> PM 42-1-7e414 <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 side of-f('OJ 6+ approximately I�v�" feet/ <br /> of V11 1.5+• , by performing the following work(description of work): <br /> G *5 r <br /> WiwAf -- <br /> Work will commence on or about X111 I LA= for approximately l MUlk 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 /> ` �n,111 <br /> � r <br /> n '� o <br /> E:1P(ISignature of Applicant-Title Date <br /> MASTER.PMENCROACHMENT PERMIT APPLICATION.DOC(01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />