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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1�4j I� OFFICE USE ONLY <br /> To; San Joaquin County <br /> JOB# -7 3 005:2_ _ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE - S' S <br /> VALID TO — 1.5 DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. BOX 930 AREA QUAD C S <br /> TYPE �R �[�al t <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 A-ZZM3242r5 <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 side of 5 t f AGI W approximately feet/rAR,-6y5LA <br /> often by performing t e following work(description of work): <br /> L.nnu` 'b ��low <br /> Work will commence on or about lT 11- for approximately !!!I 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 /> ui) c u. ai r L2 [A <br /> - <br /> Signature of Applicant-Title Date <br /> E:W MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />