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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: . <br /> Date *S— 1` + \ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE fZf - Rt a <br /> Pacific Gas and Electric Co. VALID Il_ TO -� DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA A'WtMf,4. QUAD <_9 ) _ ' <br /> Stockton, CA 95201 FORMS � i <br /> NOTES ' <br /> .' cel <br /> ( rea Code-Telephone Num er) <br /> 7Sketched plans maybe submitted) Traffic Control Plan <br /> ached sketch. Shall be as per <br /> PM `?��64-144 current M.U.T.C.D. <br /> 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 side of approximately <br /> feet/mile <br /> by performing the following work(description of work): <br /> Work will commence on or about_ for approximately® s� 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 abr in acc da ce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> ature of A i a t-Title Date <br /> EAPUB-SV.W R.PSIENCROACHMENT PERMIT ICATIOMDOC (01/08) <br />