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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��I SFJ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 i2 0 ; Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 17 -( S-1 <br /> VALID l-! /S TO 1:2 -15 t DRIVEWAYS: <br /> Pacific Gas & Electric STREET /rick Tuz.� /U <br /> P.O. BOX 930 AREA �� QUAD _ <br /> TYPE <br /> STOCKTON, Cit 95201 FORMS <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 -5 1114- 56-71 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 •GIG'j�Al: 1'%D approximately 3ol5t feet/wit IJa�t7-1 <br /> of L by performing the following work(description of work): <br /> ` <br /> 5&44 bw5 <br /> o <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 /> Signature of Applicant-Title Date <br /> E:". . KIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />