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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ,_ <br /> Date . OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 aaa- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID 14'z TO I2 DRIVEWAYS: <br /> STREET ik, t 'S'T'_ ' <br /> P.O. Box 930 AREA -!5rAeknn1 QUAD �s <br /> Stockton, CA 95201 TYPE g�zhk <br /> FORMS <br /> NOTES <br /> (2109 ) '942- 1627 _ <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic:Control Plan i <br /> SEE ATTACHED SKETCH Shall be as per <br /> PM current M.U.T.C.D. <br /> California supplement. <br /> NOTIF: � �.. �� .� } � ., � <br /> The undersigned hereby applies for permissiop to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the >y a. f side of t �Y r- L 1�4 <br /> of a t by performing the following work(description of work): <br /> Work will commence on or about . for approximately t 3 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 /> � rf � � <br /> Signature of Applicant-Title D to <br /> &SV.WKMASfERP51ErMA"D9 PEWrr AmicnnmDoc (m) <br /> Return permits to., <br /> CCD <br /> P.O. Box 930 <br /> Stnckton GA 95201-0930 <br />