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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# `3da �,L- , REF m <br /> Department of Public Works APN CR#, <br /> EXP. DATE " <br /> Pacific Gas and Electric Co. VALID kW <br /> TO s- _ DRIVEWAYS: <br /> STREETP.O. Box 930 AREA QUAD _ <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> "reae-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM _: F� r < <:' current M.U.T.C.D. <br /> Notif./ � � California supplement. <br /> FETUFIN M MR'g TO: <br /> 4WVftNLWW <br /> CA X04 <br /> The undersigned hereby applies for p ission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side side of_. 1-1f �h' A"" approximately �;' _ _JNile <br /> of si. v by performing the following work escription of work): <br /> cG✓/V c.`J�i�* [,,�� ,�/� /Q rte 6,;i''�F ;� .,y - � _ � ' + � kr <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 /> ln-c- <br /> Signature <br /> Signa ure of Applicant-Title ,'~ Date <br /> E'IPUB-SV'NK'UASTER.PSIENCROACHMENT PERMIT AP-LCATION DOC (D1108) <br />