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APPLICATION FOR ENCROACHMENT PERMIT <br /> � n:- <br /> ..., <br /> PLEASE PRINT: ?U1,14 A1.1 <br /> Date ,Oc OFFICE USE ONL �'T <br /> - - . -GHEE# __: - _ fl <br /> _-To: _ -_ San-Joaquin_County JOBS__, __- ---------.--- -- -:-: �f x: N. <br /> Department of Public Works APN CR# S <br /> EXP.DATE 1(1j--I - '2 !'•-I <br /> VALID '1-1-?01&) TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET ����-�►�e �,�•_ <br /> P.O. Sox 930 - AREA QUAD MJTYPE <br /> F _ <br /> Stockton, CA 95201 FRMS sslu-)L <br /> NOTES <br /> (-Z-07). g4-2.r 14kZ <br /> (Area Code A Telephone Number) <br /> Sketch(Detailed plans may be submitted) 1 <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM (bC>�576o current M.U.T.C.D. j <br /> Notif.[ 05� California supplement. <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach ou County Highway Right-of-Way on <br /> the side of l approximately IZ feete <br /> of 1 r�f71 �! perfor.•ng the following w rk(description of work): <br /> �t - L s�lz1JlC4 <br /> Work will commence on or about for approximately days. <br /> 1,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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> 14 <br /> Signature of Appli ant-Title ®ate <br /> E;;1PU6-SV.WKWASTERPSIENCROACHMEWPERMITAPPLICATION.DDC(07/00) <br /> Please return permit to: <br /> CCD Desk <br /> 4040 West Lane <br /> Stockton, CA 95204 <br />