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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT; <br /> Date ��Jb OFFICE USS 'ONLY <br /> To: San Joaquin County JOB # g,7- REF # <br /> Department of Public Works . APN CR # <br /> EXP. DATE <br /> VALID.. TO DRIVEWAYS: <br /> PG&E STREET � � <br /> AREAQUAD <br /> 4040 WEST LANE TYPES= � <br /> FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, .Zip Code) <br /> (Area�Co���T�t�� nNumber) - <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM2. � ! <br /> NOTIF: L�o' 7lo�Cjo <br /> The undersigned hereby applies for permission to.excavate, construct and./or <br /> otherwise-encroach on County Highway Right-of-Way as the �� side..of <br /> approximate ydo feet/mite <br /> of fxlY Irrv� by-performing the <br /> __�. ollowing Tipton <br /> of work) ' <br /> Work will commence on or about for approximately <br /> l?;0 days <br /> I, the undersigned certify that I am the owner of. the respective, property, or am <br /> qualified to represent the owner and agree to do the work described above in , <br /> accordance with the rules, regulations 'of San Joaquin County and subject to <br /> inspection and approval. + <br /> Sature of Applicant Title Date <br /> . (� . - _I <br /> MSSMM.PS\PBSS®L ce/ao> RETURN PERMITS TO: <br /> CCD <br /> PG&E 's€ <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />