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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date '7 OFFICE USE ONLY <br /> To: San Joaquin County JOB# '9 —ca REF# _ <br /> Department of Public Works APN ,_ CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID , 0 r DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA e�04>1 QUAD -,&& <br /> Stockton, CA 95201 TYPE � � e <br /> FORMS <br /> NOTES i <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 /> PM 3 013 q 89 current M.U.T.C.D. <br /> Notif. ( D 5 Z,� y 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 r-7—,,4 f side of K j!J, approximately 13S- <br /> of PP Y4ii�mile So <br /> i by performing the following work <br /> de <br /> g `Fscription of work): <br /> Work will commence on or about / t ! for approximately__ !j�, <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 inspectior and approval. <br /> Signature of A plica - itle Date <br /> E'TUB SVWKWASTER.PWNCROACHMENT PERMIT APPLICATION.DOC (01A8) <br />