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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date � <br /> I OFFICE USE ONLY <br /> To: San Joaquin County JOB# Z_ ,°F., REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ,� d <br /> Pacific Gas and Electric Co. VALID Tef DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA i62 / QUAD A,15 <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (2joq ) X42- X627 <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. <br /> -� California supplement. <br /> �,., - Y� , <br /> The undersigned hereby applies f r perpission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �" ~: side of ;n approximately ( feethrA�y� <br /> of q/" Jap/ {9 9e ff}t ///yyy by5performing the following work(description of work): <br /> A Y ■ l A..�+" p��3f <br /> Work will commence on or about �� 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 /> I)-SV.WIOMASTER.PS%ENCROACHMENTPERMITAPPUCATIONOOC (01/08) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> C+nr,k+nn (.A Q ;?n1_r)ci An <br />