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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �B 1 V l 11 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 30X REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 1 j— I 'IX: <br /> VALID TO u_1— If DRIVEWAYS: <br /> Pacific Gas & Electric STREET S;t R <br /> P.O. BOX 930 AREA L QUAD �1/E <br /> TYPE ejlh,l2 <br /> STOCKTON, CA 95201 FORMS SS ft/G,/ RZ y <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 -2)1156, 755 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 side of �1a(gP�ll} I4G1- approximately t Z�5 feet/ e �) l&6+ <br /> of J 11 by performin the following work(description of work): <br /> s�' ' cr�ya'tiar an�1. or v atj el�Gi <br /> 15-75-7 <br /> Work will commence on or about for approximately 1io 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 /> l � <br /> Signature of Applicant-Title Date <br /> E:"' . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOG (01/08) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />