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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Cil(� e�l �1 OFFICE USE ONLY <br /> To: San Joaquin County JOB# f3G�$d2..� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE l/ <br /> Pacific Gas and Electric Co. VALID $ 8 fo % S- /j DRIVEWAYS: <br /> STREET 9 �- a. <br /> P.O. BOX 930 AREA 5�'ack ,✓ QUAD $�= <br /> Stockton, CA 95201 TYPE <br /> FORMS ,e t <br /> NOTES ^� <br /> r Zf / <br /> ( rea Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30 49 71?g 3 current M.U.T.C.D. <br /> Notif. j p 2g�1 l 7�d California supplement. <br /> The undersigned hereby applies for permission to excavate, c nstruct and/or otherwise encroach on County Highw ��ight-of-Way on <br /> the eht" side of ltJ �; o approximately /o l 'tea l2I,Ir eile <br /> of C— ,ten o �-r,• <br /> 4 720 a A 7 2 2,e2 _,by performing the followingwork(desc:ription of work): <br /> rr r <br /> iti e-:6 <br /> Work will commence on or about fora roximatel <br /> PP Y- 9 C 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 /> EAPUB SV.WKMASTEP PSZNCROACHMENT PERMIT APPLICATION.DOC (01/M <br />