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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date '4111,115 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 REF# <br /> Department of Public Works APN CR# <br /> �� � � EXP.DATE <br /> 5'(A d / -�-lS <br /> n ! �( VALID - -( TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET <br /> P.O. BOX 930 AREA 71' (� QUAD S <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.b. <br /> PM -36147842 California supplement <br /> Notif. <br /> The undersiQrLed hereby applies for p rmissiDr o excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of Glfte, approximately - �7feet/wAe <br /> of G by performing the following work(description of work): <br /> X <br /> &t7_ <br /> Work will commence on or about - 15- IA —for approximately �� 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 Da <br /> "PD . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />