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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7300.5`2• REF f <br /> Department of Public Works APN _ CR f <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID �Z 4,&4pTO '_—/ •2d, DRIVEWAYS: <br /> STREET4C. I <br /> P.O. Box 930 AREA QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> 16,Z-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 <br /> PM current M.U.T.C.D. <br /> NOTI F: <br /> California supplement. <br /> The undersigned hereby applies for,permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of i � approximately �� � feetWge <br /> of ; by performing the foowi� ng work(description of work): <br /> JL <br /> Work will commence on or aboutf <br /> 3 or approximately. i �e.:r 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 �UChUv • �A�Jfth <br /> ��' a ��i ice:: <br /> Signature of Applicant•Title Date <br /> B-SV.N'KWASTERPSIENCROACHMENTPERMITAPPUCATIONDOC (07108) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> 04---1,4--- r A 09nni na,4n <br />