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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: / <br /> Date / /' / OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department ofPublic Works <br /> Pacific �� ,� Electric �� <br /> : ����|/^�� ������ ��[lw ��C}' VALID z4f 2z TO DRIVEWAYS: <br /> P.O. STREET <br /> � ���� <br /> . .� �^�J� ��° <br /> AREA I*rkAl QUAD 5-<, <br /> Stockton, ���l C]��M1 <br /> .�/ ` ���w / <br /> � <br /> FORMS <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 <br /> current M.U.T.C.D. <br /> N ot if. California supplement. <br /> 8110MION, CA 95204 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> appro <br /> by performing the following work-�aescription of work): <br /> Work will commence on or about for approximately days. <br /> 1, 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 SanJoaquin County and subject to inspection and approval, <br /> � <br /> SignatuY6 of Applicant-Title Efate <br />