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APPLICATION FOR ENCROACHMENT PERMIT ye <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# Sop�2-_ REF# <br /> Department of Public Woks APN CR# <br /> EXP.DATE , it <br /> Pacific Gas and Electric Co. VALID Wn <br /> r i/ DRIVEWAYS: <br /> P.O. BOX 930 STREET <br /> AREA O 5 <br /> Stockton, CA 95201 TYPEFORMS <br /> NOTES <br /> <2 1 `942- 162-7 <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 /> ` -� <br /> PM ° current M.U.T.C.D. <br /> NOTI F: ( . • a y California supplement. i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the lkl side of � a <br /> approximately i _ _feet! ,,�,a • ; �. <br /> of 3� `+ b Y f by performing the following work(description� <br /> of work):: <br /> Work will commence on or about a k for approximately I 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 /> o�Ch.ttu • �Q� � <br /> Signature of Applicant-Title Date <br /> LSV.WMASMUSTNCROANMENTPBWffAPPUCATIOUD,-C MlmEo <br /> Return permits to: <br /> CCD <br /> D n Rnv QW) <br />