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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date If�� I OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID �� TO z DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA c AD <br /> Stockton, CA 95201 TYPEW — <br /> FORMS <br /> NOTES <br /> Z�I 94 2- 46 2`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 /> current M.U.T.C.D. <br /> NOTIF: 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 :0 '1 —' approximately Z14, feet/mile <br /> of " 5 by performing the following work(description of work): <br /> 11(LL On <br /> Work will commence on or about_ ► . C) for approximately 480 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 /> &W.WMAA.STER.PSTNCROACHMENT PERMIT APP/ICATIOKDOC (01)08 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />