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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5I 4 f �t5 OFFICE USE ONLY <br /> To: San Joaquin County JOB# A--P ,U REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE —/ -2p1S <br /> VALID S ZG zUjO DRIVEWAYS: <br /> Pacific Gas & Electric STREET NV 4- c, <br /> P.O. BOX 930 AREA c^QUAD <br /> TYPE Y e <br /> STOCKTON, CA 95201 FORMS SM"'W <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 �)< 149 1 iq <br /> California supplement <br /> Notif. <br /> The ndersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of ArAA:& approximately (372 feet/a a NoI <br /> ofP-,mu, by performing the owing work(ascription of work): <br /> tl` <br /> Work will commence on or about 5 for approximately !9 O 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 /> LSignature of Applicant-Title Date <br /> KIMASTER-P&ENCROACHMENT PERMIT APPLICATION.COC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />