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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date NZ 5/ 115 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID ZZ-15 TO q- (S DRIVEWAYS: <br /> Pacific Gas & Electric STREET j(d�J G,c�e ✓ <br /> P.O. BOX 930 AREA kCyl— QUAD IV <br /> TYPE <br /> STOCKTON, CA 95201 FORMS h/ 612- <br /> 209-942-1627 <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 /> PM 42354'156 California supplement <br /> Notif. <br /> The ndersi ned hereby applies for permission to e cavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of Olden C�i,� AbJe. approximately 20 ' feet/mW oP <br /> of ,--`—)lam by performing the following work(description of work): <br /> J)06c. Ilb 115- <br /> 42�wz�j <br /> Work will commence on or about for approximately !10 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 /> EWU . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) - <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />