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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7_j iota -Cv REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /7 - <br /> Pacific Gas and Electric Co. VALID o >i -„ DRIVEWAYS: <br /> STREET L�f+./ ` <br /> P.O. BOX 930 AREA s�;e-x4/QUAD Vie: <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> < 1� 2- t�27 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> SEE ATTACHED SKETCH i Shall be as per j <br /> PM -4q current M.U.T.C.D. � <br /> MOTIF. California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> side of— = j?ZL - r approximately fill feetfa a ~',q <br /> of ,by performing the following work(description of work): <br /> Inpiki-lit'Lle- X71 _7 /+ & ' <br /> 1 Z 6 <br /> Work will commence on or about_;,7_)i?/ a for approximately ! days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the>own er 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 /> 4hf)l1;1 <br /> Signature of Applicant-Title Date <br /> �,&SV.WKWASTERPSOIMA"'EWPSWAPP=MK= @1106) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton. CA 95201-0930 <br />