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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Il lo'I�J OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 0D 1'2- REF# <br /> ,Department of Public Works APN CR# <br /> EXP.DATE 0 4/--/S <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas & Electric STREET AV <br /> P.O. BOX 930 AREA z1ae QUAD L <br /> TYPE <br /> STOCKTON, CA 95201 FORMS h/Gl/ lZZ."� r,-fk'iCh <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 'JI 15b�GS California supplement <br /> Notif. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Wa on <br /> the 6yLWh side of 34y m - AVL approximately. 454' feeVw#a_ <br /> of boa. e, , by performing the following work(description of work): <br /> Ir GAVQ.'ty-, I or1&�40 3 U lz �19 <br /> ce �� iIV- <br /> Work will commence on or about 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 /> y <br /> Signature of Applicant-Title D to <br /> E:WU . KIMASTER.PMENCROACHMENT PERMIT APPLICATIONDOC (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />