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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# `l�j�d �.—CA REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ;2J 151 11 <br /> Pacific Gas and Electric Co. VALID T i DRIVEWAYS: <br /> STREET ( i <br /> P.O. Box 930 AREA w 6N QUAD >w 5 <br /> Stockton, CA 95201 TYPE 1?, I ai.-E <br /> FORMS <br /> NOTES <br /> '942- I62-7 <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 �_j current M.U.T.C.D. <br /> NOTIF -7 � cel —7 -7 California supplement. <br /> The undersicIned hereby applied for permission to excavate, construct and/or otherwise encroach on County Highway Right- f-Way gn <br /> thea( side of_' 4,44-) approximately, CJI feet/- <br /> of l tY 1 ,by performing the following work(description of work): <br /> 40 41 <br /> ©� <br /> Work will commence on or about. I for approximately 1 r`?��> 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 /> Signature of Applicant-Title Date <br /> BSV.WWAASTER.PSIENCROACHMENTPERMITAPPUCATION.DOC (01101) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />