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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 0o 472-6 REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE p 3,�1 p <br /> Pacific Gas and Electric Co. VALID 210 TO /a/�sL?� DRIVEWAYS: <br /> STREET c�b�tcQ.� Vim. <br /> P.O. BOX 930 AREA SY %. QUAD $ <br /> Stockton, CA 95201 YPE a �u T � <br /> 2' ` <br /> NOTES <br /> X42- 112-7 <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 -50765 current M.U.T.C.D. <br /> Notif. j046!oo16 California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the_ side of 44_� #410, approximately !!2 feeUraile <br /> Of Jaxby performing the following work(description of work): <br /> O itavi�e 4itk L6 *X2 <br /> Work will commence on or about-- 410.111e) for approximately IPxa 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 /> J)6�0 - 26-111)If- �7 aQ 4h bo <br /> Signature of Applicant-Title Date <br /> LSV.WKWASTER,PSIENCROADIMENTPERMnAPPUCAT]OKOOC (Olio?,) <br /> Return permits to: <br /> CCD <br /> P.O, Box 930 <br /> Stockton, CA 95201-0930 <br />