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PLEASE PRINT- APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> To: San Joaquin County rOFFICE USE ONLY <br /> Department Of Public:Works JOB# ?s APN REF <br /> Pacific Gas and Electric Co. VALID DATE CR- <br /> EXP. I / /,0 <br /> P.O. Box 930 STREET DRIVEWAYS. <br /> Stockton, CA 95201 AREA <br /> TYPE QUAD <br /> FORMS <br /> NOTES <br /> -f ----------------------- <br /> A—rea Code-TelephoneNumber) <br /> Sketch(Detailed plans may be submitted) <br /> See <br /> tt C sketch. <br /> k��tc <br /> 7 Traffic Control Plan <br /> ee attached sketch. <br /> PM <br /> PM <br /> If. Shall be as per <br /> — <br /> Sketch <br /> current M.U.T.C.D. <br /> California Supplement. <br /> RETL"V TO: <br /> JOB 4am PG&E WNSK- SW I <br /> 040 L&W <br /> The undersigned hereby applies for pe . CA 95204 <br /> the < -gnission <br /> - , — ; to excavate, construct and/or otherwise encroach On County Highway Right-of-Way on <br /> of side of <br /> by perfo, <br /> Ming the following vvorkrdescriptj'��� <br /> on of work): <br /> XF <br /> Work will <br /> H-U on I or about <br /> 1, the undersigned, for approximately days. <br /> 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 nspection and approval. <br /> Signature of Applicant Tit�le ' <br /> E:"UBSVWKIMASTERPSIEPJCI?C)ACP,MEN,'PER,AITAPP�":,T!ON,Doc01,D <br /> , 8) Date <br />