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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> ,✓ i <br /> Date /t/ <br /> �- �=/ ,F �- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 06:g? REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE s <br /> Pacific Gas and Electric Co. VALID ! 16 T 2 tS DRIVEWAYS: <br /> STREET dGNa NjL__ ` <br /> P.O. Box 930 AREA k(a QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS s Q�Zg <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 /> RETURN PERMITS TO: <br /> PG&E <br /> JOB DESK- SLD 1 <br /> 40W VM4N LW* <br /> STOC KWN, CA 9504 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on5ounty Highway Right-of-Way on <br /> the .a���17` r side of approximately 3 eenile r <br /> Of (l, f ,�� 57v<� fi,-3ir by performing the following work escription of ork): <br /> X, 40 <br /> .J7 f 6- (2 <br /> r cJvi� r'<`'' a n"r .�> rf Ji�r i v <br /> —r <br /> 77 <br /> Work will commence on or about 11/125/1-10 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 /> Sig Lure of Applicant-Title Pfite <br /> EAPUB-SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DDC (01/08( <br />