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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3 - ;>'; OFFICE USE ONLY <br /> To: San Joaquin County JOB# - , REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE C' /.i,7f/ <br /> Pacific Gas and Electric Co. VALID Tb DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA ,G' QUAD ' <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> rea Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PMcurrent M.U.T.C.D. <br /> Notif. ,O 5-2 5-,.(5-06 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 So—T1* side of approximately q&8 feet4a+1e c. cs <br /> of I7=e c- by performing the following work(description of work): <br /> 1+0L.-- OL-a<5 CuT— <br /> SER Vi r' vJoQK L�� t LL t^SE Dc^SJt7CL =,,j <br /> Work will commence on or about_ Y-t f-t t for approximately o 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 /> fF-4 R /t <br /> ,nature of Applicant-Title Dat <br /> E:1PUB-SV.WMMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01,M <br />