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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> d <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73GiC15 _ (� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ®? <br /> Pacific Gas and Electric Co. VALIDo a DRIVEWAYS: <br /> STREET /,4/. _ <br /> P.O. Box 930 AREA $'f4aM/ QUAD 05 <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> Area Code-Telephone Number) <br /> Sketch (Detailed plans maybe submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 4,`3Z �. — ; current M.U.T.C.D. <br /> Notif. 1 "76) !� 1 California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the ��ST' side�f_� ,� r �ns• approximately .5-�` ee ile4/of4' <br /> of_ �.4rP.�J ell;Frk' aw. by performing the following work( escription of work): <br /> f t15't �C e Grit y <br /> � a <br /> Work will commencfor approximately days. <br /> ------------- <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 /> EAPUSSV.WK``sAASTER.PSIF4CRC)A�HNIFNT PERMIT APFIiCATICN.DOC (01,C8) <br />