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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP. DATE 3 <br /> Pacific Gas and Electric Co. VALID IZ111110 TO DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA QUAD FS <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> n e-� 1 7'� z 44 <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 3,; Z 074L� current M.U.T.C.D. <br /> Notif. 1,4cl"6169.3 California supplement. <br /> FtETURN PERMITS TO: <br /> POM <br /> JOB PROCESIINNG DESK- BLD 1 <br /> 4040 VV"LWW <br /> STOC (TON, CA 952Q4 <br /> The undersigned hereby applies for permissim to excavate,construct and/or otherwise encroach on Canty High waX Right-of-Way on <br /> theF� �t�t5 side of '�7/) ✓� approximately e mile <br /> of ✓''y ai' :moi by performing the following work escription of work): <br /> Work will commence on or about z Z /s G 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 /> r a� ZZA�2 142 <br /> S gnature of Applicant-Title D e <br /> EAPUS WINKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108( <br />