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r <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date nXz 1,Ar OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7300 '5'7 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE: 2-157 -/ 57 <br /> VALID ¢-/;-/S TO7T—1,F DRIVEWAYS: <br /> Pacific Gas & Electric STREET (y�p 0,— <br /> P.O. BOX 930 AREA - QUAD <br /> STOCKTON, CA 95201 FORMS TYPE <br /> T�en ch <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> slialI be as per <br /> See attached sketch. current M.U.T.C.O. <br /> California supplement <br /> PM -51 l o 9a'e'2 <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 40[& Df: approximately 0P4' feet/mile lk <br /> of Hnry Aa- U\. , ��V—b 1 _, by performing the following work(description of work): <br /> VAZA—VA-1d, l adhl IIIGPI <br /> W-PtIVI J2 <br /> Work will commence on or about 10Zo t for approximately 0 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 /> Signature of Applicant-Title Date <br /> UP MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01/08) <br /> Return Perrr)its to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />