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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> d � <br /> Date ( OFFICE USE ONLY <br /> To: San Joaquin County JOB# Z-;tea.,.elREF# <br /> Department of Public Works APN CR# <br /> EXP.DATE v<% <br /> Pacific Gas and Electric Co. VALID 0 S — DRIVEWAYS: <br /> STREET gQ�, dGH <br /> P.O. BOX 930 AREA QUAD lac <br /> Stockton, CA 95201 TYPE �4 k <br /> FORMS <br /> NOTES <br /> <2,t-)q ) '942— a62- 7 <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 /> PMS=- ; <br /> SC-7" � 'I current M.U.T.C.D. <br /> NOTIF: P � , �- <br /> California supplement. <br /> � ' ��� 1;? <br /> The undersi d hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the_ side of- 11J�'I}(�- told approximately 15:7 feet/ h <br /> of V LGMn by performing the following work(description of work): <br /> ! hole 4t�-; r,� t�.? f1 X(J�lIrk <br /> Work will commence on or about_ I I�' 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 Date <br /> f <br /> LV.WKWASTEPPSIENCRIDACHMENT PERMIT APPLICATIONAOC (OMB) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />