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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2 -_ /i�' - ,f." — OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works APN REF <br /> CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID TO <br /> 17�T_ DRIVEWAYS: <br /> P.O. Box 930 STREET <br /> AREA QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Area Codex-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM -3 <br /> current M.U,T.C.D. <br /> I Notif. 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 cis . sitleof qL. <br /> of approximately._ V4 y feet/A4 <br /> by performing the following work.(description of work): <br /> .1A i 'e5 '7/ 140 Lt '0 7/9 1 ' /4AJa <br /> A.1 <br /> Work will commence on orabout --------'_1 _ ___ <br /> _--.ZZ - .2011 for approximately. 4,10 days. <br /> 1, 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 /> I" Signature of Applicant-Title <br /> Date <br /> E'PU&SV.WKWASTERPS�EYCROACHMENT PzRMJI APPUCAIIOK000 01108) <br />