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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> P-� I <br /> Date . c OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3 / 1/ <br /> Pacific Gas and Electric Co. VALID t® TO r� J/ DRIVEWAYS: <br /> STREET ZV f4 . <br /> P.O. Box 930 AREA --`Prozkrate QUAD IoU5 ` <br /> Stockton, CA 95201 TYPE 13Ez.L R-OL <br /> FORMS 25/lvx�, <br /> NOTES <br /> <� � `�4 2- ►l 2? <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 4 12'9,I57 . current M.U.T.C.D. <br /> MOTIF: 1t:�: - 0 California supplement. <br /> Theu dersi ned hereby applies for perrni5sion to excavate constr ct 4ndlor otherwise encroach on County Highway Right-of-Way on <br /> the side of r ` icirnaiyehr f�Atftl�ileti <br /> of by performing the following work(description of work): <br /> 7-1 <br /> -1 <br /> Work will commence on or about for approximately 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 /> B-SV.WIOMASTER.PS%NCROACHMENT PERMIT APPLICATION.00C (01M% <br /> Return permits to: <br /> CCD <br /> E) n D--awn <br />