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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date T5 OFFICE USE ONLY <br /> To: San Joaquin County JOB# '7s rjp,'Z, �_ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE LS-Id 20 1 Z-( <br /> Pacific Gas and Electric Co. VALID /- TO , 1 .-2et DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA QUAD )4f-� — <br /> Stockton, CA 95201 TYPEFORMS S I,t9 2 r2►�� C }+r►S ,I'�if• <br /> NOTES <br /> cT5�7. Z t)Z <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 /> PMS -1'LO current M.U.T.C.D. j <br /> California supplement. <br /> I <br /> 1 <br /> The under igned hereby applies f r permission to excavate,construct and/or otherwise encro ch on Cpunty Highway Right-of-way on <br /> the side of c) approximately feetlat#a _ <br /> of by performing the following work(description of work): <br /> G f.� <br /> Work will commence on or about for approximately days. <br /> I,the undersigned,certify.that I am the owner of the respective properly,or am qualified to represent the owner and agree to do the <br /> work es 'bed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> . � t <br /> .� 2' l3 <br /> Signature of Applicant-Title Date <br /> E•WU&SV.WKVAASTER.PSIENCROACHMENr PERNTAPPLICATION.DOC(M) <br />