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i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ,°J ,f; f `A OFFICE USE ONLY <br /> T <br /> To: San Joaquin County JOB# � 1�- , REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE , d9 <br /> VALID $ d 0 Zip DRIVEWAYS: <br /> P G &E. CO, STREET <br /> 4040 WEST LANA' AREA QUAD <br /> TYPE <br /> STOCKTON, CA 95204 FORMS <br /> NOTES / <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> i <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM :r� '1' ;''v current M.U.T.C.D. <br /> Motif. Californlia supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on Cou�)Aiork <br /> Highvda Right-of-Way on <br /> the r�/; side of ,F'r�' 1 approximately P�, ee � <br /> of ` _, by perforating the followindescription of work): <br /> ' s!� ;!'!� '1�'L,%'r`� ,�a.•' �`"a /f !it F?....J. <br /> Y4 7ftf• /l+"i'9 Ifo I <br /> 1 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 /> t'/fir <br /> Signature of Applicant-Title Dafe <br /> E.IFUB-SU.WIC,MASTER.nENCROACHM,ENTPE MITAPPLIW,ON.000 <br />