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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2 Z <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas & Electric <br />P.O. BOX 930 <br />STOCKTON, CA 95201 <br />209-942-1627 <br />Sketch (Detailed plans may be submitted) <br />See attached sketch. <br />PM -;�)1 10 <br />Notif. <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP.DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Traff is Control Plan <br />shall be as per <br />current M.U.T.C.D. <br />California supplement <br />The undersigned hereby applie for perm. cion to vxcavate, construct and/or otherwise encroach on County Highway Righ of -Way on <br />the side approximately c..a' DZ feet/mile <br />of w ice` T , by performing the following work (description of work): <br />Work will commence on or about for approximately izo 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 />4Aq \On r <br />'u -/ '2�2111� <br />Signature of Applicant - Title Date <br />': . RIMASTER.PMENCROACHMENT PERMIT APPLICATION.DOC IWO - <br />Return Permits to: <br />CCD <br />P.O. Box 930 <br />Stockton, CA 95201-0930 <br />