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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date � <br /> - OFFICE USE ONLY <br /> To: San Joaquin County JOB# - ' ' Z�-�o <br /> Department of Public Works REF# <br /> APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. <br /> VALID 2 o 6 1 DRIVEWAYS: <br /> P.O. Box 930 STREET <br /> Stockton, CA 95201 TYQUA° - -- <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may besubmitted) <br /> SEE ATTACHED SKETCH Traffic Control Plan <br /> PM �,,� Shall be as per <br /> i U <br /> MOTIF: current M.U. D. <br /> C.�-. 4 ��� ` . . r I <br /> l California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wav on <br /> the _ ._ side of i�i`� <br /> of_ 1- �. -� approximately tq-r.� feet/miie•_�P�-- <br /> �� by performing the following work(description of work): <br /> Work will commence on or about •7� I t for approximately— 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 /> o U ju)u - ��a�J r s <br /> Signature of Applicant-Title `" € r <br /> Date <br /> e-SV.Wtt1M%E-SUCROACHMENi PEW1RAPPI.ICkTloNAOC (11081 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton. CA 95201-0930 <br />