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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date `�� (O l+Gi J OFFICE USE ONLY <br /> To: San Joaquin County JOB# _L3 by S—Z.. REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID 2-7-2otl TO G'/ q DRIVEWAYS: <br /> STREET Bey, oy-1d. <br /> P.O. BOX 930 AREA QUAD u t,-S <br /> Stockton, CA 95201 TYPE <br /> FORMS S Sl��Lo 2 <br /> NOTES <br /> 1627 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH Sha be asffictr e� Plan <br /> P <br /> PM ;5�04 561!5117 current M.U.T.C.D. i <br /> NOTI F: 1046 Z4644- California supplement. <br /> fk <br /> The undersigned hereby applies for <br /> permission to ecavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of &J)d dC 1`S� approximately- 2 7 feethmiia K 6 4 r <br /> of by performing the following—work(description of work) <br /> Work will commence on or about_1 1 p I for approximately Colz4ll I 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 /> �a� ( _ l 2� ►� 10 <br /> Signature of Applicant-Title Date <br /> 6SV.WKvl0.sreRvsl CROAMMFxrrE7U+UAWUCAnoKDac MM <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />