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, <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 61--��' .. ( OFFICE USE ONLY <br /> To: San Joaquin County JOB# ��j� to REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE 15 13 <br /> Pacific Gas and Electric Co. VALID To DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA k`r60 QUAD-65 <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> 7— <br /> (Area <br /> (Area Code-Telephone Number) <br /> [Sk�etc—h(D—etailecl plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM S oy'Y78 3y current M.U.T.C.D. <br /> Notif. f� Zo Z c31 California supplement. <br /> thee undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> side of F /2 /�U 6. approximately /b f� (fee7mile <br /> of /art h oii u ,�/� 45 <br /> _� /l�o�U by performing the following work(description of work): <br /> 5 t JGA d.� /,o /) h'X �� /3C/�-14/0/1 i N <br /> Work will commence on or about f D - /'?— i Z <br /> for approximately / Edays. <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 /> wor!'-described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> z <br /> Signature o Applic t-Title Date <br /> E:11PUB-SV.WKWIASTER.PSIENCROACHMENT PERMIT APPLICATION.000 (0108) <br />