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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ - D' OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7�5 - REF u <br /> Department of Public Works APN CR <br /> EXP. DATES•�� <br /> Pacific Gas and Electric Co. VALID (�3.l0 TO '. DRIVEWAYS: <br /> P.O. Box 930 STREET y-1v ir4 <br /> AREA S�-Cat--rrjL/ QUAD /✓ ' <br /> Stockton, CA 95201 TYPE �� <br /> FORMS <br /> NOTES <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 ';' q ` ' 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 me s <br /> 24, side of :�' 11 4� .S i., approximately ' c " feet/A44e <br /> of lY14y,rzt L�3 .S'T0,4,1 VAI by performing the following work(description of work): <br /> DrE/ do-.� --�� � �`, .ALL O�c7�.E 1..�..)l�t-S x�s�rr✓.�'`�'t� �,c.•' e'�r� <br /> Work will commence on or about— z' --2 -r, 3 for approximately <br /> 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 /> - ASR &AS <br /> Signature of Applicant-Title Z--- Date <br /> EtPU35'.WKWASTER.PSIENCROACHNIENT PERMIT AFP-CAT.ON.000 (01/06) <br />