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APPLICATION FOR ENCROACHMENT PERMIT <br />•J OFFICE USE ONLY <br />,.JOB.#__"._7.3iJ.il~?ui~"GQu~f¥-_:-.-_........•.---.•..~-RfiE-#-.~-'--_.~'--' <br />nt of P~blicWorks APN CR#, <br />EXP.DATE 5-1-16 <br />s and Electric C.o.'VAUD 3 UP TO-y/~!6.DRMWA¥S; <br />,STREET La/Jlgfl..V1 .'.•W~LNo.'AREA StoGktOll QUAD LV • <br />TYPE I ..•CA 95204-FORMS f(,lJjt ~q l~ch )pe(If~.r-NOTES <br />, <br />g/la-Uta7 <br />ode.Telephone Number) <br />,Pacific Ga <br />404D <br />Stockton, <br />PLEASE PRINT: <br />Dale dAtJ 6 \\f.o <br />(4b6'\ <br />,.(Area~ <br />Skekh (Detailed plans may be su~mitted) <br />-.-'"To;...,;~..-SanJoa~ <br />Departme <br />See attached sketch.PM8HE84E5NotifJlbG31Sf:b ' <br />I'!Traffic Control Plan <br />Shall qe as,pef";current M.U.T.C.D. <br />I"C~lifornia _sUJl?~ment. <br />Please return permit to:ceo Desk <br />4040 West Lane <br />Stockton,CA 95204 <br />days.,for approximately <br />Please return permit to:ceo Desk <br />4040 West Lane <br />Stockton,CA 95204 <br />,~'gna!lire of APPJjc.:.~t.Titl.hA<:-'E:Jj.. <br />SV.~AI'I'ISA (IJI.«lEl <br />the undersi ned,certifY,thal,amthe owner of the respective property,or am qualifiedto representthe owner and agreeto dothe <br />ark cn bove in accordancewith the rules and regulations of SanJoaquin Countyanti subject to inspection and approval...,..