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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin bounty JOB# REF 4 <br /> Department of Public Works APN CR# <br /> EXP. DATE ? <br /> I <br /> LID TO Z'y yo E DRIVEWAYS: <br /> �J EO <br /> Pacific Gas and Electric Co. VASTREET <br /> P.O. Box 930 AREAE QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMSf*v"A-W2 dZ <br /> NOTES <br /> (Area�Code-�Telepho�neftm�ber) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C,D. <br /> Notif. California supplement, <br /> The undersigned hereby applies forpermission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the f side of approximately r6ethnile <br /> of by performing the following workRZription of work): <br /> Work will commence on or about for approximately days. <br /> 1,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 /> Signaturevof Applicant-Title Date <br /> E\P;BS'.1,111`,MAST'R.PS\ENCROACliMENrPERrAITAPPIICATION.D-,)C (01/08) <br />