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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# -734n5�2 REF# <br /> Department of Public Works APN CR# <br /> -0"' E USE, <br /> ONLY <br /> EF� <br /> C <br /> EXP. DATE <br /> VALID U TO <br /> Pacific Gas and Electric Co. 1!'/49 DRIVEWAYS: <br /> STREET <br /> J�V <br /> 6 <br /> P.O. Box 930 AREA iQUAD <br /> L 'P <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM <br /> current KUT,C.D. <br /> Notif. <br /> 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 ol <br /> of <br /> approximately <br /> by performing the following work(description of work): <br /> 16- <br /> Work wilt commence on or about_ ""' , / . : . for <br /> mately days. <br /> 1, 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 /> ask <br /> 122 <br /> Signature of Applicant-Title <br /> 571) Date <br /> E1PUBSV,WKIMASTEPPSILNCROACHMEN7 PER (01108) <br /> APPLICATION.DOC <br />