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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7S, REF# _ <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID fSZ410 TO G DRIVEWAYS: <br /> STREET ,�1r <br /> P.O. Box 930 AREA VZ=aOIIUAD���Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. ; California supplement. <br /> Thee uncers�igrled hereby applies for permission to excavate, construct and/or otherwise encroach n County Highway Right-of-Warr on <br /> f side of - approximate) <br /> of <br /> by performing he following work (description of(description <br /> -71 <br /> Work will commence on or about for approximately <br /> days. <br /> I, the undersigned, certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of pplicant-Title `s <br /> Date <br /> -PA SV.WK`dJ,ASTERPSIENCROACHMENT PERMIT A.PPLIaJON.7OC (01108) <br />