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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date A OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7;4ra-Ga REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE !! !a <br /> Pacific Gas and Electric Co. VALID 9 �� TO //r �o DRIVEWAYS: <br /> STREET EGL A <br /> P.O. BOX 930 AREA 61y&M ✓ QUAD u15 k <br /> TYPE -�►.x1�. <br /> Stockton, CA 95201 FORMS <br /> NOTES <br /> (2pq ) 94 2- «,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 41 zz 1 4 current M.U.T.C.D. <br /> California supplement. <br /> Notif. Ip,4&47S6 <br /> The undersign d hereby applies for p rmission to excavate,construct and/or otherwise encroqch on County Highway Right-of-Way on <br /> the side of 4.1o' ° I approximately A-4- Gd�'('LQ- feed <br /> of �/ � ,by performing the following work(description of work): <br /> u �i Z c> <br /> Work will commence on or about Aff 7,1 for approximately 11612 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 /> 3DJ),hj - . "W'pf- (�&�2 4izi�Acl <br /> Signature of Applicant.-Title Date <br /> t..WKWASTEP PSENCROACHMENT PERMIT APPLICATIOKDOC (01100) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> S;tnnktnn CA 95701-0930 <br />