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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ _ � 4 : 114- OFFICE USE ONLY <br /> To: _ San Joaquin-County _ JOB# REF# . <br /> Department of Public Works APN CR# <br /> EXP.DATE Z-16,-Zy I-q <br /> Pacific Gas and Electric ®, VALID 44-14-2o114 TO -! -Lcx�{ DRIVEWAYS: <br /> ' STREET <br /> P.O. Box 930 AREA QUAD ,$\ <br /> Stockton, CA 95201 TYPE <br /> FORMS I,t} <br /> - NOTES <br /> C1 52- 258Z <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 7k�8 current M.U.T.C.D. <br /> Notif.�p�� `�. California supplement. <br /> CI ) ZitX � <br /> 1 " <br /> C3� 4 15a Hot.-E-5 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroac �onty Highway Right-of-W y on <br /> the _ side of C� 1��"r' (J MF n, approximately feet/ <br /> of _ ` Q �� WWSt� ,by performing the following work�dscruitlon of work): <br /> FL HP HWA ZX4PPe>z <br /> c�c t_(_. <br /> '} t <br /> 4 <br /> Wor will commence on or about for approximately I 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 /> wo ed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> 4 , . <br /> Signature of Applicant-Tit Date <br /> E.'IPNBSY.WRIMASTEUS(ENCRMCWdENTPERMRAPPLICATIDN.DOC(01108) <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />