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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: „J <br /> Date 1 OFFICE USE ONCE <br /> To San-Joaclufri.Coun 2-DS- <br /> Department of Public Works APN CR#. <br /> EXP.DATE <br /> VALID TO DRiVEWAYS: <br /> Pacific Gas and' Electric C.Q. STREE-.- s -/- * <br /> �5 ri �I_ AREA 5tan k f0i7 QUAD 4Z S <br /> TYPE 11 <br /> Stockton, CA .9520+ Oell <br /> FORMS W <br /> NOTES <br /> (Are5 Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as <br /> per <br /> PM current M.U.T.G.D. <br /> Motif. California supplement. <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br /> uridersicIned hereby applies far pegls�* to e��y e,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> L <br /> approximately ;a <br /> side Of <br /> by performing the following Work(description Of work): <br /> as <br /> A will commence on or about for appfoxfmate--- <br /> ly--- <br /> ?e undersigned, certify that I am the owner of the respective property,or am qualified-10 represent the owner and agree to do the <br /> ibed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval, <br /> Signature of Applicant 1N <br /> "! <br /> VWKIMASTERPS(ENCROACHMENTPERMITAPPL1 T I., t <br /> —7 <br /> Please return permi to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton,CA 95204 <br />