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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4114I 15 OFFICE USE ONLY <br /> To; San Joaquin County JOB# 73001<2;, REF# <br /> Department of Public Works APN I CR# <br /> EXP. DATE -js ZG/ <br /> VALID 5fO -7-/'-2C> DRIVEWAYS: <br /> Pac i f is Gas & Electric STREET kyJC' <br /> P.O. BOX 930 AREA QUAD S� <br /> TYPE L 4U <br /> STOCKTON, CA 95201 FORMS ss�(n Zai <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-;511-3 California supplement <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 4�:L 'fl side of C-- khU.Yar - approximately SSo' feet/wiie W&66 <br /> of MdAk4a, , by performing the following work(descriptio of work): <br /> oad- <br /> J-= ldcA. A,,--,Lu <br /> Work will commence on or about bil I for approximately 90 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 /> Qan \ Fob)Y" �Ohrpzi� -4/t4115 <br /> LSignature of Applicant-Title Date <br /> KIMASTER.PSENCROACHMENTPERMITAPPLICATION.DDC(01/08) <br /> Return Permits to.- <br /> CCD <br /> o:CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />