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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 0/17/14— OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730L_l REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z-1 1S <br /> VALID t2–1 _ 14 TO -/� _ DRIVEWAYS: <br /> Pacific Gas & Electric STREET 1 �n rye <br /> P.O. PDX 9 0 AREA „(P QUAD �_ ^ <br /> TYPE <br /> STOCKTON, CA 95201 FORMS <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 /> California Supplement <br /> PM -:;511150 <br /> Motif. <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 .,r,nrr I approximately 3S2 ' feet/ 1�&__ <br /> of AVN't ' , , by performing the following work(description of work): <br /> &UYath 4i". WOr V- til o �- <br /> a��n <br /> Work will commence on or about L for approximately fl 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 /> UA \03D aWU ' I)f &tV,2 114- <br /> Signature of Applicant-Title Date <br /> E:1P . PoMASTEPPSIENCROAGHMENTPERMITAPPLICATION.DOC (010) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />