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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date jv r OFFICE USE ONLY <br /> To: San Joaquin County JOB# 39e9f�`Z- REF <br /> Department of Public Works APN CR# <br /> EXP. DATE S ,r <br /> Pacific Gas and Electric Co. VALID l4 T DRIVEWAYS: <br /> P.O. Box 930 STREET aQ. <br /> AREA QUAD �. <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> L <br /> (Area Code-Telephone Number) <br /> Sk7Seeattached <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> sketch. Shall be as per <br /> PM 4/41c'! current M.U.T.C.D. <br /> Notif.jv�`�� ' California supplement. <br /> RETURN PERM TS TO: <br /> pow <br /> JOB DESK- KD 1 <br /> 4W <br /> 8100KTiCMI. CA95W4 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Wa on <br /> theside of .orf", approximately of-- 'it /�-�� ice' — PP Y e mile <br /> by performing the following work description of work): <br /> 5:f'1e/c'Z;.:�C..� (J`y,�s �'i!'vk.'.. zf G7 !.0 �r�"S iCnC: t .• <br /> Cr <br /> Cal <br /> Work will commence on or about y <br /> for approximately days. <br /> `6 C <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 jv <br /> Date <br /> E:IPIIB-SV.'NMMASTERPSIENCROACHMENT PERMIT APPL',CATIONLOC (07(08) <br />