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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> t <br /> To: San Joaquin County JOB# rt3 —Z_�, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID d T iS' r1 DRIVEWAYS: <br /> STREET = <br /> P.O. BOX 930 AREA tftoorl QUAD S� <br /> Stockton, CA 95201 TYPE <br /> FORMS Sb Ww <br /> NOTES <br /> 1 <br /> <4- <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 /> RETURN PERIMITS TO: <br /> Pam <br /> JOB DESK-BLD 1 <br /> 40 0~Lw* <br /> 81OCKTON, CA 95204 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right-of-Way on <br /> the,jZ„•.�7;4' side of—Z4, , �c,o::y' approximately F et/�'ile <br /> a roximatel l <br /> of �'�P �>% l2 ; fy ,� by performing the following work escription of work): <br /> r <br /> Work will commence on or about 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 /> E:1PUB-SV.WKIMASTER.PMENCROACNMENT PERMIT APPLICATION.DOC (01108) <br />