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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ` <br /> ✓ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73ocrsz-6Ga REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE id <br /> Pacific Gas and Electric Co. VALID ip o ?a,a DRIVEWAYS: <br /> STREET &n-4 go, <br /> P.O. Box 930 AREA �� i j QUAD SE ' <br /> Stockton, CA 95201 TYPE '°RFzt. -tots <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 >'4 "':'.^4N _ current M.U.T.C.D. <br /> Notif. y< California supplement. <br /> The undersigned hereby applies for permission to excavate construct and/or otherwise encroach oCoty Highway Right-of-Way on <br /> the side of approximately ._' t"fe�t�nile <br /> PP Y of >>J; %' i <`,''% ,T- ,rr7, : �, by performing tie following work(description of work): <br /> .[� ,'.- j ,<:1l J'1J, `�,,, �� �; - f+r►+-.. .r �` !'M f"'it ."''Y" _ <br /> Work will commence on or about t c<' for approximately 2 days. <br /> � r . <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 /> ,rell c.'' <br /> Signature of Applicant-Title f Date <br /> E:1.PUBSV,VXVJASTER.PSIENCRCiACHtAENTPERWITAPP!ICATION.DOC (01M) <br />