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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> To: San Joaquin County <br /> Department of Public Works JOB OFFICE USE ONLY <br /> '-�� <br /> APN REF# <br /> EXP.DATE CR# <br /> Pacific Gas and Electric Co. o <br /> VALID <br /> P.O. BOX 9330 STREET �sF �r DRIVEWAYS: <br /> AREA tGt ?�✓, <br /> Stockton, CA 95201 TYPE QUAD <br /> —= ----- ` <br /> FORMS <br /> NOTES <br /> 494 2- 162-7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH Traffic Control Plan <br /> PM = �� ,. �- Shall be as per <br /> � '�.--�;� curve <br /> NOTIF: i; nt M.U.T.C.D. i <br /> California supplement. <br /> The undersigned hereby applies for permi <br /> the ssion to exc vate,construct and/or otherwise encroach on County <br /> of approximatelyr my Highway Right-of-Way on <br /> side of <br /> feetth to <br /> r �. <br /> by pertormmg the following work(description of work): <br /> �� <br /> , <br /> Work will commence on or about <br /> 1, the undersigned,certify that I am the odays. <br /> wner of tl�e respective P roeor or am qualified to represent the owner and agree to do the <br /> for approximately F <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> Signature of ApplicakTitle�'�-��( <br /> &SV.WI(05TEP PSOC14CHMENT P D to <br /> ERMIT.MPLICATICINDCC (pique <br /> Return permits to: <br /> CCD <br /> on Rnv Qqn <br />