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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINK': <br /> Date OFFICE USE ONLY <br /> San-Joaquin_Couniy_= <br /> -- - . <br /> - - - — -_? REF_#. <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific f Gas and Elect"IC Co. VALID � `/-1 TO ���-�f /� DRIVEWAYS; <br /> STRE40`z.) � l l._lv. a AREAET �� QUAD <br /> Stockton, CA 95204- TYPE <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone_Number) <br /> Sketch (Detailed plans may be submitted) <br /> - 1 <br /> Traffic Control Plan <br /> See attached sketch. Shall he as per i <br /> PM I I(c, -�( current M.U.T.C.D. <br /> Motif. -fcl,+ California supplement. <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> I <br /> Stockton, CA 95204 <br /> I � <br /> .The undersigned hereby applies for permission to excavate construct and/or otherwise encroach on County Highway Right-of- ay on <br /> the —'S'4- A side of e • —approximately_ ZI�_— _feeY <br /> n — <br /> �-of by performing the following work(description of work): <br /> Work will commence on or about _ - for approximately days, <br /> 1,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 /> w�L- <br /> E'-IPUB-SV.WKIMASTERPSfENCROACHMENT <br /> above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> c l <br /> Signature of Ap lic nt e Title ale <br /> PERMIT APPLICATION.DOC(01108) <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />