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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �� I <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works REF# <br /> APN CR# <br /> EXP. DATE X01 <br /> VAL <br /> Pacific Gas & Electric TRD n T _�Li12w� Ay DRIVEWAYS: <br /> P.O. BOX 930 AREA yl e-te-Mil QUAD GG <br /> STOCKTON, CA 9'5201 TYPE �eei 1-faLE ' }�6yQ`c <br /> 209-942-1627 NOTES -FORMS551t.r�, .�2,7 <br /> Sketch(Detailed plans maybe us b im ett ett tl) <br /> Traffic Control Plan <br /> See attached sketch. shall be as per <br /> current M.U.T.C.p. <br /> PMS California supplement <br /> Notif. �` �� <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach Cay on <br /> '�z�c <br /> the ; side of ; t -,� on County Highway Right-of-VII <br /> of , fit;; �, approximately j -feet) <br /> 7 Y tr'T� by performing —the following work(description of work): <br /> Work will commence on or about --r <br /> • for approximately �� -µ�' 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 /> Date <br /> EVU& MMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />