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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date i if)Ao OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALIDJ3-20-2d( TO _(_ DRIVEWAYS: <br /> STREET 111' Aw, <br /> P.O. Box 930 AREA QUAD WS _ <br /> Stockton, CA 952'01 TYPE Ab W& 1? - <br /> FORMS r.VrnJ _ <br /> NOTES <br /> 2c t- z Y `!`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 "3 c`7 k/1-5-60 current M.U.T.C.D. <br /> Notif. i o y 7 $ ,i dC 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 approximately feet/mile <br /> of by performing the following work(description of work): <br /> Work will commence on or about_ 3 fis to for approximately t t( 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 /> EAPUB SV.WKW1lSTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/108) <br />