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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:+7 <br /> Date t-- ,� - /Q OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1300 - REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID �O I �a DRIVEWAYS:STREET' g <br /> P.O. Box 930 AREA -eli-b QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES ' <br /> i <br /> 20q ) �— <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 3U '��',5dv current M.U.T.C.D. <br /> Notif. y3 California supplement. <br /> The and rsigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SIE 'efn k E2 &a4 Zj <br /> R1, 0I <br /> f EPLACE , by performing the tollowing worK taescription of work): <br /> �x i S I—IA Z LAS F i L i TIES 13�' G►l' T.�'�it/GY/�t/� <br /> Work will commence on or about_ - 9 -j(1 for approximately SID da s. <br /> Y <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 /> �) - az AAs Z'/D <br /> Signature of Applicant-Title -STJM y�oJ2 Date <br /> ER BSV.W"AASTPUMENCROACHMENT PERMIT APPEICATION.DOi" (01108) <br />