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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I— OFFICE USE ONLY <br /> To: San Joaquin County JOB# 'r;mS-;;�.- REF _ <br /> Department of Public Works APN CR:E _ <br /> EXP. DATE <br /> g , t o a o DRIVEWAYS: <br /> Pacific Gas and Electric Co. VALID STREET sser'TA;, <br /> P.O. Box 930 AREA Jf QUAD FS <br /> Stockton, CA 95201 TYPE 1�16L_ . H04-E <br /> FORMS `�tal� le- <br /> NOTES -2.7NOTES <br /> +off 1J a <br /> rea 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 /> Notif. California supplement. <br /> • <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highr,�ay_Right-of-Warr on <br /> the ,��k —_side of <br /> . '�• : � y—_approximately <br /> of .� ��` =� ,�; by performing the following work(description of work): <br /> Work will commence on or about for approximately E _ 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 /> Sig bre of Applicant-Title Date <br /> E:1PUB-SVWKW,ASTER.PSIENCROACHPAENTPERMI?A;?LICATIGFi.DGC: (01M) <br /> i <br /> s <br />