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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _j� ,t OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 CSL �(� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID T 11 DRIVEWAYS: <br /> STREET _ <' ' <br /> P.O. BOX 930 AREA e e/ QUAD Nlf, ` <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (2Pq ) `942- t�27 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> SEE ATTACHED SKETCH Shall be as per j <br /> PM _:�:Y) - current M.U.T.C.D. <br /> NOTI F: <br /> California supplement. <br /> ��:1���.�� ��� � ,�.. j � <br /> The undersi ned hereby applies for p rmissign to excavate, cons ct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of v �-=' approximately I _, .�` y feet/rs#e <� <br /> of nuc -� by performing the following work(description of work <br /> 3 p <br /> 5 <br /> t <br /> Work will commence on or about_ for approximately 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 /> Signature of Applicant-Title Date <br /> �.SV-M%MSTEPMMCMAMME?ffPMMffMPUWOMDOC 011081 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> .qtnrktnn r A q.99ol-ricno <br />