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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ° OFFICE USE ONLY <br /> To: San Joaquin County JOB# "?3ooSZ--�, REF <br /> Department of Public Works APN CR# <br /> EXP. DATE t, <br /> Pacific Gas and Electric Co. VALID „ L Po t0 DRIVEWAYS: <br /> STREET l Oln C ". . <br /> P.O. Box 930 AREA S-r4r4 QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS 5 L✓ v, -ZQ <br /> NOTES <br /> (A a Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. California supplement. <br /> RETURN PERI W8 TO: <br /> pem <br /> JOB PROCESS 00 DESK-BLD 1 <br /> 40 0~LXX <br /> 81000 N. CA 95204 <br /> The undersigned hereby applies for permission to gxcavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the �" _side of— approximately ,. fiee-Vmile <br /> —_— fes'. by performing the following work (description of work): <br /> Z", ! �...L`y±.. bf :�,�"s4 yam/';,„.., �:�y. 6 ^" '`� <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 /> Ir Signature of Applicant-Title Date <br /> E:IPUBSV.WKGAASTEP..PSIENCROACHMENTPERMITAPPLICAT1014.IDOC (07!09) <br />