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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date i � OFFICE USE ONLY <br /> —�� <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas & Electric Company, PG&E VALID ► i _ TO i !r DRIVEWAYS: <br /> (Applicant Name) STREET f _ <br /> f, r AREA QUAD <br /> Pixel e l 0A TYPE o� � <br /> (Mailing Address) FORMS *41waj <br /> r <br /> .��) NOTES a� <br /> (City,State,Zip Code) <br /> 916-760- <br /> (Area <br /> 1F-760-(Area Gose-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> �,.Y k I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the e- 5-r side of approximately �,,t-: feet/mile -.-4 <br /> of by performing the following work(description of work): <br /> Please refer to construction drawinas for work locations. <br /> PG&E will be replacing the existing overhead conductors and from time to time_re_ Ig acingop les, equipment <br /> and r I�acing/removing/installing down guys as required. <br /> Work will commence on or about 11 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 de5obed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Y - <br /> - Signature of Applicant-Title Date <br /> E'.IPU&SV.WKIMASTER.PSIE4CROACHMEMPE.4M,TAPPLICAiI0N.DOC (01U) <br />