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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��� L-/5 OFFICE USE ONLY <br /> - To: San Joaquin County JOB# 73 (20S2- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ¢-1 -- ( S <br /> VALID � _ TO - I -I S DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> AREA QUAD <br /> P.O. BOX 930 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 /> PM -51 )'Z- lee-21 California supplement <br /> Notif. <br /> The undersigned hereby applies,for ermission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the - side of M. A44approximately 6e2 feet/mile �t�1 <br /> of V� e _,by performing the following work(description of work): <br /> Work will commence on or about for approximately 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. \06D, <br /> Signature of Applicant-Title — r��Date <br /> E:N . KIMASTER.PSIENCROACHMENTPERMITAPPLICATIONDOC(01108 <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />