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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4 <br /> OFFICE USE ONLY <br /> To: San Joaquin County FAPN <br /> -(p REF# <br /> Department of Public Works CR#Pacific Gas and Electric Co. O // �, �� DRIVEWAYS: <br /> P.O. Box 930REET <br /> AREA �J?dck-scf/ QUAD IV..5 <br /> Stockton, CA 95201 TYPE o T <br /> �• FORMS u/1t1 <br /> NOTES <br /> -, <br /> (Area Code Telephone Number) <br /> 7Se <br /> h (Detailed plans may be submitted) <br /> e attached sketch. Traffic Control Plan <br /> ta <br /> PM �=-�}.��` Shall'be as per <br /> - current M.U.T.C.D. <br /> Notif. d Z.�._14`1-ff;l California supplement. <br /> oThe undersi ned hereby applies fo permission to excavate,construct and/or otherwise encroach on County Highway Right -11.- on <br /> e __side of �- approximately -, <br /> by performing the following work(description of work): <br /> `tet > <br /> ,q dr <br /> Work will commence on or about t <br /> for approximately <br /> - :::=- 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 /> Signature of Applicant-Title <br /> j Date <br /> e PUB S7 4 RPSEN=ACMENT PMC APPucanox.00c (mush <br />