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7 P <br /> AP' 3: APPLICATION FOR ENCROACHMENT PERMIT <br /> � �' I � �111 <br /> PLM&PRINT: <br /> Date l OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73ppja- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID 1d 0 d fs `0 DRIVEWAYS: <br /> STREET GWAj Ate, t <br /> P.O. BOX 93O AREA .:5r, -1q QUAD <br /> Stockton, CA 95201 TYPE «kap <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 6 eollG' current M.U.T.C.D. <br /> Notif. Ip supplement. <br /> ,'6 <br /> California <br /> The undersigned hereby applieq for permission to excavate,construct and/or otherwise encroach on County Highway Rightf W <br /> tay on <br /> of of — approximately_ C _feet <br /> by performing the Iowing work(description of work): <br /> Work will commence on or about for approximately. I 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 Applicant-Title Date <br /> tB-SV.-WKWASTEP PSIENMAWMENT PERMIT APPLICATION.DOL (01/08) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />