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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ; - OFFICE USE ONLY <br /> To: San Joaquin County JOB# " 3oo's-2-- REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE L-54 <br /> Pacific Gas and Electric Co. VALID STREET f� � TO ta5 — DRIVEWAYS: <br /> 's <br /> P.O. BOX 930 AREA �, ,' UAD Alar <br /> Stockton, CA 95201 TYPE � �Aakf- A- 'MACH <br /> FORMS,, +:.v—s <br /> NOTES <br /> 194 2- 16 -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 /> PM current M.U.T.C.D. <br /> California supplement. <br /> NOTI F: <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the :f , i side of t :� T��. � approximately . —i", � feet/*Ae <br /> of . . ;: f , s s.i;Y„ , ,x ` ,. �: - by performing the following work(description of work}: <br /> v_ <br /> Work will commence on or about_ ? u-'-" 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 JoaquirrQount*and subject to inspection and approval., <br /> L\B,SVMKWASTEP <br /> Signature of Applicant-Title Date <br /> .PSENCROACHMEW PERMIT APPUCATIOk DOC (01108; <br /> Return permits to- <br /> CCD <br /> P.O. Box 930 <br />