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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date r"" OFFICE USE ONLY <br /> To: San Joaquin County JOB 73oog2_G, REF 71r1 _ <br /> Department of Public Works APN CR# _ <br /> EXP.DATE /D-/!5-.D 9 <br /> VALID 7,09 TO JD.rS-d9 DRIVEWAYS: <br /> P.G. &E. CO. STREET ag,Q�V � <br /> AREA <br /> ,Q <br /> 4040 WEST LANE TYPE �,g,,f�-, QUAD ` <br /> -�� ,r� <br /> STOCKTON, CA 95204 FORMS 19 <br /> NOTES <br /> y <br /> Area Code•Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM �714 7 f current M.U.T.C.D. <br /> Notif. �! California su i <br /> e�-` pplement. <br /> The undersigned hereby applies fofpe`mission to excavate,construct and/or otherwise encroach o Coity Highway�Right of Way on <br /> the _x� .� , >�sideof YrL d/ f �' , approximately G� v� f feetkile � X4"'5 <br /> of_ yc"- f / .,,,� = w .4fn by performing the followin Arork(descr�ption of work): <br /> �,�.fin ���� f t,./.7,{./ �Y.. �y�rte:I'�TC j �'r• <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 /> % U <br /> Sg atature of Applicant-Title to <br /> E1PUB-SV.WKWAST"cRPS1ENCRCACHMEMPERG,RAPPLICA'ICIV.DCC (01108) <br />