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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> A <br /> Date 6/ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7360, 2_ , REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 4 , <br /> Pacific Gas and Electric Co. VALID t T q DRIVEWAYS: <br /> STREET t �,yg Ai/6 <br /> P.O. Box 930 AREA ff17 <br /> Stockton, CA 95201 TYPE ---�— QUAD <br /> FORMS �w�u,, <br /> NOTES <br /> Kirea Code-Telephone/Number) <br /> 7Sketched plans may beTraffic Control Plan <br /> ached sketch. Shall be as per <br /> PM �(�? current M.U.T.C.D. <br /> Notif. California supplement. <br /> RETLMN PERMITS TO: <br /> PME <br /> JOB DESK- BLD 1 <br /> 4040~Lana <br /> STOCKrON, GA 965204 <br /> The undersigned hereby applies for permissiorl to excavate,construct and/or otherwise encroac on Comity Highwa Right-of-Wa on <br /> thea S'1—' side of r7/, ��i'%, �� �'c/F' approximately < <br /> of L>� �� Tapp Y ee ile vt <br /> ' by performing the following work( escription of work): <br /> 4-1— <br /> , <br /> zv <br /> /�� � r / i ✓� 1 C�/�-ice/. /`.. <br /> 1 [/ <br /> Work will commence on or about for approximatelyE 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 to <br /> E.iPU&SV.WKIMASTER.PSIENCROACHMENT PERMIT APP6CAT10N.DOC pijoa) <br />