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APPLICATION`.FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT; ., <br /> Date l` `�fJ — OFFICE QS$ 'ONLY <br /> TO: San Joaquin County JOB # /Jl30so�'tc, REF <br /> Department of Public Works APN CR # <br /> EXp. DATE <br /> VALID._!m- .o TO ate. DRIVEWAYS: <br /> PG&E STREET <br /> AREA. 4 ISE <br /> 4040 WEST LANE TYPE -�It 14 at <br /> FORMS. twu3� -29 <br /> STOCKTON, CA 95204 'NOTE <br /> (City, State, Zip Code) <br /> X20°!7�►A2- 121 <br /> (_Area Code Telephone Number)., <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PEP <br /> CUPPENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> SEE ATTACHED SKETCH <br /> PM 878 <br /> NOTIF: <br /> The undersigned hereby applies for permission to.excavate, cons. ruct and./or <br /> o he ise- cr a h on Countg Highway Right-of-Wa on-the <br /> approximately feet/as=& <br /> ofki)a As , by "per€ormi-nq the <br /> - - oliop-Wi �• _ 1dscription of-work) : -- 4X <br /> •C.� l GJ <br /> Work will commence on or about for approximately <br /> ` days. <br /> I, the undersigned certify. that I am the owner of. the re spective, 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 atone of Applicant Title —7Date <br /> Sttur <br /> MA=.PS%F=S®n (6100) RETURN PERMITS TO: <br /> CCD <br /> PG&E <br /> P.O. BOX 930 <br /> STOCKTON.CA 95201 <br />