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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /z' - ; J - ''j OFFICE USE ONLY <br /> To: San Joaquin County JOB# X35 -- , REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID 1'P-Z?-/0 TO f-l= (( DRIVEWAYS: <br /> P.O. Box 930 STREET ,vt�g Sr. <br /> AREA �r ^J QUAD g�s_ t <br /> Stockton, CA 95201 TYPE L4- H��E <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 current M.U.T.C.D. <br /> Notif. 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_649z,17t� side of E .S y' ,S'1, approximately S� <br /> Of T/-1EL/Y1/t /�r��, ppry feetii:R4 6qs7 <br /> by performing the following Work (description of work): <br /> Work will commence on or about for approximately �3� <br /> 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 <br /> G Date <br /> EAPUB-SV.WKIMASTERPSIENCROACMMENTPERMRAPPUCATION.DOC (01/08) <br />