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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73665-Z–(o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE , /4 <br /> VALID 1 4 0 �s DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET E�AGEE <br /> P.O. BOX 930 AREA :!��Aj QUAD A16 <br /> Stockton, CA 95201 TYPE '3 fly Bow <br /> FORMS �fwy�,P Z4, T✓� �yj <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 -3100--7751 j current M.U.T.C.D. j <br /> Notif. 10-78'7cj3 I California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the JcuTe-r side of D . approximately—771 feetkift <br /> of by performing the following work(descripti(n of work): <br /> S <br /> 5/b <br /> Work will commence on or about O for approximately days. <br /> i <br /> I,the uncle ' ed,certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> wor scr' d above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> I o Z8 l <br /> 'j•A}�SJSiignature of Applicant-Title <br /> ate <br /> E1PU KIMASTER.PSIENC A16, TAPPLI N.DOC"(01100)'��� <br />