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REC€(YED <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> aJAft4%Nf.0 AM 11: Of <br /> 1 u. K S OFFICE USE ONLY <br /> To: San Joaquin County F,�,, <br /> B# 7 `j"�-(o REF# <br /> Department of Public,Works CR# <br /> EXP.DATE <br /> VALID 0 J DRIVEWAYS: <br /> P G. &E. CO STREET WA Ri, <br /> 4040 WEST LATE AREA —rozA Gy QUADTYPE �, 1 <br /> STOCKTON, CA 95204 FORMS <br /> LL b t� <br /> NOTES <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 /> L�'7Z/J J_3 current M.U.T.C.D. <br /> Notif. /03,?r'777 , California supplement. <br /> I <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 Ca/- G,p <br /> Of � rt� ,yam/ � '� �� aPProximately ile gf <br /> — `� <br /> ��'" by performing the following work escription of work): <br /> ---22/- IL, QQn�u�t, 4- <br /> /�f'� fjz/ ? V /) <br /> Work will commence on or about_ ? t <br /> )u( approximately r>>, <br /> 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 /> '7 <br /> Signa ure of Applicant-Title __- ` <br /> Datec <br /> EIPUB.SV.WKIMAS1ERPSENCRo AC.4MENT PMR APPLICATICNAgC (01108) <br />