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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ —71-g/ / /?_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73006-_ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S Z <br /> Pacific Gas and Electric Co. VALID46V6,PQ__ <br /> TO �I j� DRIVEWAYS; <br /> STREET <br /> P.O. Box 930 AREA 57 !MAJ QUAD CS ' <br /> Stockton, CA 95201 TYPEdLG. <br /> FORMS S5 .jV <br /> NOTES <br /> 7- <br /> (Area Code-Telephone Number) <br /> 7See <br /> h (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> attached sketch. Shall be as per <br /> M ,3og3 q 9Lf` current M.U.T.C.D. <br /> Notif. ID &,13 3&3't 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 _5. UL),41A) ,2 X V E approximately. 790 �dmile /U <br /> Of­ f1 a,e WE,Q ,4 v s��e�v� , by performing the following work(description of work): <br /> 13o/w eAcf'oi'F Svc iu.4i',V <br /> Work will commence on or about ez for approximately F0 <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 inspection and approval. <br /> FSignature - �{ e <br /> o Appli ant Title Date <br /> EAPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPUCATION.DOC (01108( <br />