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APPLICATION FOR ENC ROAC;HENT PERMIT <br /> PLEASE PRINK': <br /> Date �C f ' OFFICE USE ONLY <br /> ._To -_-__-_San-Joaquin=County - -_- - - -- .- - __-:JOB.#—._- ��2-__REF#----------__:—__ =_—_-- - <br /> Department of Public Works APN CR#. <br /> EXP.DATE 0 2ols <br /> VALID (;1 -2 TO /(�t,�l Z,>fy DRIVEWAYS: <br /> Pacific Gas and Electric C.Q. STREET -�F `�T T . <br /> Wi s�11 L_�A ' AREA e QUAD .SS <br /> Stockton, CA 95204 TYPE FORMS - I <br /> NOTES <br /> C� � i - - <br /> n <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) 1 <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM -311-76110 current M.U.T.C.D. j <br /> Notif. I 1 CSG l Gc Y7 - i California supplement. <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br /> .The and rsigned hereby applies for perm�i�s$'l,q„np env ,construct and/or otherwise encroach on County Highway Right of ay own <br /> the side of F-- .� approximately feet/ T4 <br /> of a ,by performing the following work(description of work): <br /> Work will commence on or about for approximately AZ5 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 /> wor c d above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval,. <br /> Signature of Applicant-Tit e sr Date <br /> E:1PUB-SV.WRIMASTER.PS(ENCROACHI4ENi PERMITAPPUCATION.DOC tol/OB) <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />