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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ..* r OFFICE USE ONLY <br /> To: San Joaquin County JOB# 131��- REF# <br /> Department of Public Works APN _ CR# <br /> EXP. DATE l )l <br /> Pacific Gas and Electric Co. VALID }ts TO �r DRIVEWAYS: <br /> STREET )V6,' <br /> P.O. BOX 930 AREA QUAD W3 ` <br /> Stockton, CA 95201 TYPE FSI[ goy <br /> FORMS <br /> NOTES <br /> (2Pq ) `942- !1027 — <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 ?)o ,. current M.U.T.C.D. <br /> MOTIF: <br /> California supplement. <br /> The undersi ned hereby applies for per ussi n to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the . side of � —approximately t '7" feed= <br /> of 3vcby performing the following work(description of work): <br /> *0 Iti. home— <br /> Work will commence on or about_ 77 !1 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 Joaquin County and subject to inspection and approval. <br /> I Cal <br /> — — Date <br /> Signature of Applicant-Title Date <br /> 6sv.WK1MASTERPSUCROACHMENT PERMIT APPLICATIOK00C: (DV08) <br /> Return permits to.- <br /> CCD <br /> o:CCD <br /> P.O. Box 930 <br />