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APPLICATION `FOR ENCROACMMT PERMIT <br /> PLEASE PRINT: . <br /> -D8 OFFICE. IISE:ONLY <br /> Date <br /> TO: San Joaquin County JOB # 7302 REF # <br /> APN <br /> CK # <br /> Department of Public Works EXP. DATE ,3 <br /> VALID. 8-�-d TO / - >a DPavzwAYS: <br /> STREET l9BALIS <br /> PG&E ARF.P fix c2P4 = <br /> TYPE o E T NG <br /> 4040 WEST LANE FORMS, <br /> STOCKTON, CA 95204 NOTE <br /> (City, State, Zip Code) <br /> (Area 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 /> f- <br /> CALIFORNIA SUPPLEMENL-,"` <br /> SEE ATTACHED SKETCH(S). <br /> PM 30613010 <br /> NOTIF: <br /> The undersigned hereby applies for permission to.excavate, .Con.s•truct and/or <br /> otherwise--encroach:on County Highway Right-of-Way: 177 L4g9l l4 S LDefATIOAIS <br /> cr tion of:work) ��� �y — - <br /> 1 _ F_ <br /> Work will commence on or about lc - dLT-DB for approximately <br /> CIO 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 /> v o32 LAS EsrImnroR S-Zy -CSS <br /> Date <br /> gnature of Applicant - Title <br /> r "I J <br /> 62 1 VP - <br /> ML9=M.PS\Fn C3ML (6100) RETURN PERMITS TO: <br /> CDAI 7-i4C7": CCD <br /> (�14�1�y YYI/9DEi�FI PG&E <br /> 9'Y2, P.O. BOX 930 <br /> FU 2 nM V IV' F/N L Z� STOCKTON,CA 95201 <br /> < <i�� , <br />