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APPLICATION FOR ENCROACHMENT PERMff <br /> P J- <br /> J j�a `� <br /> PLEASE PRINT: 4 ;; J <br /> Date " OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.�de!j z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE t ( 1 _ <br /> Pacific Gas and Electric Co. VALID /a TO 0 DRIVEWAYS: <br /> STREET ,e <br /> P.O. BOX 930 AREA it/ QUAD )q _ <br /> Stockton, CA 95201 TYPE <br /> FORMS S Z�— <br /> NOTES <br /> (2jr;q ) X42- �12� <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 current M.U.T.C.D. <br /> Notif. IGY� 4a California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the � _side of <br /> approximately.5n�4' t667� feet/mile 14/LF <br /> of L41 by <br /> Uperforming the following work(description of work): <br /> . tjf& , <br /> t <br /> Work will commence on or about '1 Ito for approximately _ Imo? 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 /> to <br /> Signature of Applicant-Title Date <br /> B-SV.WKWASTERPS%ENCRDACHMENTPERMITAPPUCAT10KDW (011W <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> -qtnrkfnn (.A gri7n1_nq-An <br />