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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINt: <br />Date OFFICE USE ONLY <br />To:_. San Joaquin_Couniy-- -_- - JOB.#. <br />Department of Public Works APN CR#. <br />EXP.DATE <br />VALID -23-.20rjT0 1C)-31-2y 15 DRIVEWAYS:Pacific Gas a.nd C.Q.Electric . STREET <br />4,040 X15 L A AREA .Site) puA <br />Stockton, CA '95204- TYPE <br />FORMS - Z 6- <br />NOTESNOTES 1 tl <br />Gla vv'_ 11 635 soli <br />l v I / K%f'./`' `f 4'-=>., tt 'l' G ti' ,•v/ t 5 tt/ 7/•j <br />Area Code-Telephone Number) <br />Sketch(Detailed plans may be submitted)1 <br />Traffic Control Plan <br />See attached sketch.Shall be as,per <br />PM -311-3 Z4o1 current M.U.T.C.D. j <br />Notif. JC)C>1(o- 64_ i California supplement. <br />Please return permit to: <br />CCD Desk <br />i4040WestLane <br />Stockton, CA 95204 <br />The undersigned hereby applies fo permissi n to excavate,,co struct and/or otherwise encroach on Cou ty Highway Right-o-Way onthe — side of approximate(y_feetf t ' ' 1ofoL ot• ,by performing the following work(description of work): <br />v Com. <br />Work will commence on or about for approximately days. <br />1,the undersigned,certifythat(am the owner of the respective property,or am qualified to represent the owner and agree to do theworr( above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br />Signature ofApplicant 4 Tiffs pat <br />NUB-SV.WKWASTER-PSiENCROACHMENr PERMITAPPLICATION.DDC(0110BJ <br />Please return permit to: <br />CCD Desk <br />4040 West Lane <br />Stockton,CA 95204