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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date 4:!�?i <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# -7`g�Z-'.� REF# <br /> APN CR# <br /> Pacific Gas and Electric Co. EXP. DATE <br /> o--�= <br /> VALID ., .• TO l0-. <br /> P.O. BOX 930 STREET v, G DRIVEWAYS: <br /> Stockton, CA 95201 ARE '�� K QUAD <br /> TYPe t•e <br /> FORMS <br /> NOTES <br /> C2,0q ) 2- ica2 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may besubmitted) <br /> See attached sketch. Traffic Control Plan <br /> PM ��!-7 I� Shall be as per <br /> Notif. 04current M.U.T.C.D. <br /> ����� California supplement. <br /> The undersi n d hereby applies;or permission to excavate,constnact and/or otherwise encroach on Co <br /> un e side of unty Highway Right-of-Way on <br /> -- approximately � �_feet/mile <br /> by-performing the following work description of work <br /> Work will commence on or about <br /> D <br /> � �g • wr approximately 10114W,1,the undersigned,certify that I am the owner of the respective property,or am qualified to re days. <br /> present 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 on and approval.. <br /> p <br /> Signature of Applicant-Title <br /> t'-SV-WKW-EPP51ENCRO Date <br /> ACHMENf PERMIT APPLIC4TION.DOC (01,081 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />