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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# r130oS�-(a REF>#T <br /> Department of Public Works <br /> APN CRr <br /> EXP. DATE ( '� t► <br /> Pacific Gas and Electric Co. VALID io 0 TO ( it DRIVEWAYS: <br /> P.O. Box 930 STREET led- vt• <br /> AREA sr-�crQUAD IrdS _ <br /> Stockton, CA 95201 TYPEi c kat <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> 7See <br /> h (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> attached sketch. <br /> Shall be as per <br /> M 's current M.U.T.C.D. <br /> Notif. = '�" '; ,�� California supplement. <br /> lL:Tt W Pa*AT3 Tp: <br /> ANVY10CEOeM3 IDESK- et„01 <br /> strno , CA 95204 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Wa on <br /> thew: ` o <br /> of ,C'�— f <br /> T <br /> side_" approximately <br /> imw fee'�mile t�'� �Y.._A <br /> Y performing the following work description of work): <br /> e + <br /> Z' , 1" <br /> �; .,; <br /> Work will commence on or about � <br /> —�---, 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 `,.. <br /> Date <br /> EAPUE SV.WK',MASTER.PS.ENCROACHMENT PMAIT APPLICA.TICLDCi <br />