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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 75005 REF# <br /> Department of Public Works APN _ CR# <br /> EXP. DATE 06V1 <br /> Pacific Gas and Electric Co. , VALID �e�•�0 TO Zzv DRIVEWAYS: <br /> STREETvnrcd.4a °✓�, <br /> P.O. Box 930 AREA QUAD 155 <br /> TYPE EtnGE <br /> Stockton, CA 95201 FORMS <br /> NOTES <br /> (0,c;q ) 1942- !G2? <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 mac='? current M.U.T.C.D. <br /> California supplement. <br /> NOTIF: <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 approximately_ feet/p <br /> of by performing the following work(description of work): <br /> i:1 zz vile rZo �rnclL <br /> Work will commence on or about_ 41;-'14. 10 for approximately d� 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 /> &SV.WKNIJSTER.PSIENCRDACHMENT PERMIT APPLICATION.DOC PAM <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />