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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works _ REF# <br /> APN CR# <br /> EXP.DATE 0 L6) <br /> Pacific Gas and Electric Co. VALID s �f d T 1 c' DRIVEWAYS: <br /> P.O. BOX 930 STREET V7#V ASL. <br /> AREA Sra�k-ris N QUAD 65 <br /> Stockton, CA 95201 TYPE _-� 4 - <br /> FORMS <br /> NOTES <br /> 1627 <br /> (Area Code-Telephone Number) <br /> 7Sketched plans may be submiTTACHED SKETCH Traffic Control Plan <br /> Shall be as per <br /> PM S 4e';" ! + current M.U T.C.D. <br /> NOTI F: , <br /> California supplement. <br /> The undersi ed hereby applie for permission to excavate,construct and/or otherwise encroac <br /> the side ofh on County Highway Right-of-Wa n <br /> }r <br /> of 3.-�il1I approximately Y <br /> by performing the following work(description of <br /> ) <br /> S� J <br /> Work will commence on or about <br /> for approximately it_ ,r <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to days. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and appro ahe <br /> � c,11u,, ' - L a_Q' � <br /> Signature of Applicant-Title <br /> r Date <br /> 6SV.WKWSrEPPSUCROACHMENTPERMRAPPUCATIOXDOC pjcq <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />