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I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /Zy l j Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works APREF# <br /> N CR# <br /> EXP. DATE z <br /> Pacific Gas and Electric Co, j VALID 4 T / j2 DRIVEWAYS: <br /> P.O. Box 930 j STREET uMoe— ,QD. <br /> Stockton, CA 95201 � AREA ����� QUAD <br /> TYPE LG 1�d1.6 <br /> FORMS <br /> NOTES <br /> Z <br /> f-)g_ ol2/� -/S �' 9 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per ! 1 <br /> PM 301365-25- ' ' current M.U.T.C.D. <br /> Notif. (p� 0'?01 I <br /> ��3 California supplement. <br /> the <br /> undersigned <br /> igned hereby-applies for permission to excavate,construct and/or otherwise encroach on County Highway Ri ht-of-Wa on <br /> S <br /> ide of_IF. C o 11 �l2 !Z p a roximatel 2 D <br /> of C� 41 t� F.e-n e�P C�zT PP Y fe mile y <br /> �� by performing the following work(description of work): <br /> �GQ J.4 f.Q ( f ) y'x Y� 3,e// <br /> F� rfri.Q S S d� <br /> Work will commence on or about /Z <br /> for approximately 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 App scant-Title <br /> Date <br /> E:IPUB-SV.WKIMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC (01MB) <br />