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APPLICATION FOR ENCROAC T PERMIT <br /> PLEASE PRINT: <br /> Date 4�f �✓I U8 <br /> OI.'RICS II$8 ON LY <br /> To: San Joaquin County JOB # 73W57_-(C REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE hD•I • <br /> VALID. 12. 1•® '. TO RI•/,5 DIENAYS <br /> PG&E STREET i <br /> AREA 4040 WEST LANE TYPEUAD <br /> � -- <br /> STOCKTON, CA 95204 FOIE <br /> NOTE <br /> RMS <br /> (City, State, .Zip Code) <br /> C2 � ��T�(Area Codeephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.0-D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM 4 1 v9 <br /> NOTIF: <br /> The undersigned hereby applies for permission to.excavate, .construct and/or <br /> otherwise-encroach on County -Highway. Right-of-Wa-r-on the side of - <br /> approximately _ feet/ _rQ,, <br /> of L' _ �Dlarada�, by-per€ormixig the <br /> _w..o_rk_ d_e*_;cript on of work <br /> Work will commence on or about O <br /> l days.. <br /> for approximately <br /> �G <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 /> S ature of Applicant - Title Date <br /> MASTSR.PS%FSBS®L (6100) RETURN PERMITS TO: <br /> CCD <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON,CA 95201 <br />