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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 41-:5ohc OFFICE USE ONLY <br /> To: San Joaquin County JOB# ; 4� 4' y-6 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE o <br /> Pacific Gas and Electric Co. VALID �" v TO v DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA QUAD t�(0 <br /> Stockton, CA 95201 TYPE al— <br /> FORMS <br /> alFORMS — <br /> NOTES <br /> �Z� � ��2- ►�z7 <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 5:.';r7"[ZO!5 , current M.U.T.C.D. <br /> Notif. 1 o47?9q- California supplement. <br /> The undeTsiigned hereby applies for permission to excavate,construct and/or otherwise encroach on C my Highway Right-of-Way on <br /> the —Wet+ _side of pproximately tom. 40wrage � <br /> coG df 61+10– — byperforming the following work(description of work): <br /> ( J70f1L12 Al <br /> v <br /> Work will commence on or about— ZG for approximately. 1 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 /> WYAh <br /> Signature of Applicant-Title Date <br /> t...K�WASrERPS"CROACHMENT PERMIT APPLICATIOkDOC (01108) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> r o aC�onl noon <br />