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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73' U O�Z REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 7– <br /> VALID — — 19 TO I '(S DRIVEWAYS: <br /> Pacific Gas & Electric STREET Cron (-rL/1 e1dz Qd <br /> P.O. Box 93o AREA %_u d i QUAD /l/ <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 3I1Z-1 q 0'�) <br /> Notif. <br /> Theyn�dersi n d hereby applies for pee mission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Eft side of 40 –v 1 0– approximately III zo feet —QC)(—hl <br /> of—5 M 1 k I1"1%61– t _, by performing the followipg work(description of work): <br /> E- t Xyl' i <br /> 1 <br /> Work will commence on or about for approximately IC) 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 /> Q��r) \Offiawu . 17( -Z/ 15 <br /> Signature of Applicant-Title Dkte <br /> E:1P . MMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC(D7/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />