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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date r = <br /> JOB# ,� p�"�P REF# <br /> To: San Joaquin County APN CR# <br /> Department of Public Works <br /> EXP.DATE <br /> VALID 0 DRIVtdvHY S: <br /> Pacific Gas and Electric Co. STREET <br /> * <br /> P.O. Box 930 <br /> AREA AD <br /> Stockton, CA 95201 TYPEFORMS <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 /> PM 3 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 /> g r4j- approximately '-- `` feetlmile C- <br /> the side of (r,3r / It�C' - - <br /> r k� �. - ,by performing the following work(description of work): <br /> -,u - <br /> 4,r7 T' <br /> A blA <br /> 0 9 <br /> Work will commence on or about ' for approximately c'' days. <br /> I,the undersigned,ned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work describe above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> -� Z- Via/ <br /> �---- - �� vt iT�Z-. ��T1� �- Date <br /> Signature of Applicant-Title <br /> E.1PUB•SV.WKWASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />