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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ° ' ' OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7306$0 —to REF# <br /> Department of Public Works APN _ _ CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID !iTO o it~� DRIVEWAYS: <br /> P.O. BOX 930 AREAET -57G�c,C�-y QUAD " <br /> Stockton, CA 95201 TYPE � <br /> FORMS <br /> NOTES -- <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> No current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the i side of Pe c--e.-4c A 0ca, <br /> approximately feet/mile �:_ <br /> of_ .� t , LO <br /> by performing the following work(description of work): <br /> Work will commence on or about for approximately_ I 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 Date <br /> E:{PU&SV.WKVAASTERPS�ENCRO,k,HMENT PERMIT APPLICATION.DOC (al" <br />