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... r. <br /> 2g1D DF<. 19 PM 3- 11 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> rC;R <br /> Date 4 OFFICE USE ONLY <br /> To: San Joaquin County JOB# M057aZ-to REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l I/'0 <br /> Pacific Gas and Electric Co. VALID TO DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA 4f Vpl QUAD _ <br /> Stockton, CA 95201 TYPE �04�04 <br /> FORMS 3 G1Il!/4 Z <br /> NOTES <br /> �Z X42- «27 <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('ZJ O I L current M.U.T.C.D. <br /> Notif. lrv1 + California supplement. <br /> The undersigned hereby applies for permissi to expavate,construct and/or otherwise encroach on County Highway Right-of-Way o <br /> the Itb04+-) side of�� 6+ approximately <br /> of _-*ye by performing the following work(description of work): <br /> Work will commence on or about. for approximately 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 -D&e <br /> L"NK"ASTER PSTNCROACHMENT PERMIT APPLICATI(DUCC (01= <br /> Return permits to.- <br /> CCD <br /> o:CCD <br /> P.O. Box 930 <br /> I;tnrkton rA 95201-0930 <br />