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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date 21 / it <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# �' REF# <br /> APN r CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID _ T <br /> P.O. Box 930 STREET DRIVEWAYS: <br /> Stockton, CA 95201 TYPE QUAD AREA er i <br /> FORMS <br /> NOTES <br /> (Ar Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> PM 3d83�y Shall be as per <br /> Notif. current M.U.T.C.D. <br /> California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way <br /> the ®u,� r_side of L ge-t-f F 1 g y on <br /> Of. T 1?,egc y f oT� approximately____ 3 fee*i4e 7- <br /> by performing the following work(description of work): <br /> U0/l7 <br /> Work will commence on or about <br /> for approximately_ _ �o p <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree days. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> g e to do the <br /> ,, pp al. <br /> signature of Applicant t't" ? t 1 <br /> BPU&SV.WKNMSTERPSIENCROACHMENT PERMIT APPLICATION.DDC (01/8) Date 4 <br />