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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: t <br /> Date _g �`� I� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73cy5�_Cr.� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE oZ, t5 31 <br /> VALID !a TO a 7>' i'(_ DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET 0- <br /> P.O. BOX 930 AREA QUAD t46 <br /> Stockton. CA 95201 TYPE <br /> FORMS, R-L <br /> NOTES ` <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 "8A current M.U.T.C.D. <br /> California supplement. <br /> NOTI F: 10-1yM 4 <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way n <br /> the side of approximately a feet/piTrQ�i <br /> Of Lby performing the following work(description of work): <br /> I <br /> Work will commence on or about 140 for approximately J80 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 /> LSV.W0AAS'rEP PSIENCROACHMENT PERMIT APPLICATION.DOC (OV08) <br /> Return permits to: <br /> CCD <br />