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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ':�4' OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1'11a05-Z (- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Gtr• i 5-0'7 <br /> VALIDTO $• (s•dg DRIVEWAYS: <br /> P.G. &E. CO. STREET daeNEY L_ 1. ` <br /> 4040 WEST LANE AREA J,om>t QUAD <br /> TYPE &Z4 h61-E <br /> STOCKTON, CA 95204 FORMS <br /> NOTES <br /> I <br /> rea Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM .36 7140100 current M.U.T.C.D. <br /> Notifi. o3840g1 California supplement. <br /> The undersigg,n,ed� hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the l°T side of f�4ew'y y /-ni. approximately Z 9' fe Lt�FST" <br /> of 11/Cl//S �a,p� by performing the following work(description of work): <br /> X• ',.✓ A/ r VJi 5i4 0 7m tom,. <br /> 3 •v. Lo • , e r Cvg Ve- <br /> er /'/)1 ,3 Z a m{r yet r <br /> Work will commence on or about or appy imately e 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 /> • Gas �,�l� p/ � <br /> Signat re of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.00C (01108) <br />