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APPLICATION VOR EWCRQACMONTPEPWIT <br /> "Loll, PRINT: <br /> OFFICE. USS ONLY <br /> Date <br /> JOB # ? /afJREF # <br /> To: San Joaquin County APN CR . # <br /> Department of Public works . EXP. DATE <br /> VALID-. .TO 2:/ DRIVEWAYS: <br /> in1C9 <br /> PG&E <br /> STREET <br /> �- <br /> . I iREA, �m QUAD -!�—.= ----- <br /> TYPE L o4!G ?,C '/ * <br /> 4040 WEST LANE FORMS <br /> STOCKTON, CA 95204 NOTE <br /> (City, state, .Zip Code) <br /> 2 D t �1 y� - f.� <br /> (Ares Code Telephone Number).. <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENZ--•'" <br /> SEE ATTACHED SKETCH <br /> PM <br /> NOTIF: �r�'1 3DB <br /> applies far permission to.excavate, construct and./or <br /> The undersigned hereby PP oa the <br /> otherwise encroacl3 on County='Highway. Right-of-Wa:y - ,$OGlTiV <br /> zl approximately 1`�`� feet/fie <br /> lay"per€oZZ[17T1g the <br /> followinS�zs —(s tai on of-worker A le - <br /> Lxcs�v r'� <br /> Al — PiavitZT . <br /> for approximately <br /> Work will commence on or about <br /> days., ' <br /> I, the undersigned certify. that I am the owner ofproperty, or am <br /> . the respective <br /> cribed <br /> e work de <br /> qualified to represent the owner and <br /> nonsgof San Joato do thin County sand subjecteton <br /> accordance with the rules, regula '. <br /> inspection and approval. <br /> EST�rv��7109 . <br /> pate <br /> gnature of Applicant Title <br /> K,jTM.Fs\aM1SCE1DL ss/ooh RETURN PERMITS TO: , Z -01 , ` <br /> CCD I <br /> PG&E 17 <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />