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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ' C% OFFICE USE ONLY <br /> To: San Joaquin County JOB# '1-5 Z_e, REF# <br /> Department of Public Works APNCR# <br /> EXP.DATE t <br /> VALID S 3d ko to _3 t . DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. BOX 930 AREA 953ork-" QUAD E5 <br /> Stockton, CA 95201 TYPE n°ip <br /> FORMS <br /> NOTES <br /> '942- l62I <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 2+1current M.U.T.C.D. <br /> California supplement. <br /> NOTIF: ic'47�AZ� <br /> The undersigned hereby applies for pGr_mission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wayon <br /> the side of��''�t7 AL _approximately <br /> of Q in by performing the following work(description of work): <br /> l.mow e a4E .e r U a. <br /> _rV Life_Work will commence on or about e� for approximately n 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 /> Ito <br /> )1 Signature of Applicant-Title Date <br /> :tPU&SV.WKIMASTERPSIENCROACHMEIR PERMIT APPUCATIOPLOOC (07104 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br />