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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Z S l` OFFICE USE ONLY <br /> To: San Joaquin County JOB# V_;40Q..6 REF# <br /> Department of Public Works APN 0 CR# <br /> EXP.DATE I // /3 <br /> Pacific Gas and Electric Co. VALID 3 TO /f 3 DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA QUAD AAAJ <br /> Stockton, CA 95201 TYPE FORS 6 !� � <br /> _ NOTESf of <br /> k <br /> Z' <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan ; <br /> See attached gkA+nti Shall be as per <br /> PM _ 3 o q '-1-7 I (Pj current M.U.T.C.D. <br /> Notif. California supplement. <br /> OW q 1711/3 I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the -5 side of (4-9_ t 0fC1'Z ri' \p (20' approximately 'S1 fe_/mile 1,C) <br /> of t;2 c oenl/ ,by performing the following work(description of work): <br /> Work will commence on or about L for approximately /Xb_ 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 /> n <br /> Signature of App ant-Title Date <br /> E:IPUB-SV.WWASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br />