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,RECEIVED <br /> APPLICATION FOR ENCROACHMENT PERMI?010 NOY 17 PM 4: 13 <br /> PLEASE PRINT: ',E P T «` p';u <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE it <br /> =2- 0-1 DRIVEWAYS: <br /> ib TO —� <br /> Pacific Gas and Electric Co. VALID STREET �rc�a �—__ <br /> P.O. Box 930 AREA ev-- ,A QUAD i <br /> Stockton, CA 95201 TYPE - �- i+pwc- , <br /> FORMS 55_ <br /> NOTES <br /> (2pq ) 942- 1627 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> SEE ATTACHED SKETCH Shall be as per j <br /> PM ' 1 '" 4'° =' current M.U.T.C.D. <br /> NOTI F: _ California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the ,a t side of t;: <br /> J <br /> rM approximately feet/ e 4- <br /> of x I' j , f Vis- ,! by performing the following work description of work): <br /> ).2- <br /> J, <br /> Work will commence on or about— a <br /> --E 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 Date <br /> . .."ASTEPPS%NCRDAMMENTPERMITAPPLICATION.DOC ITim% <br /> Return permits to: <br /> CCD <br />