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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date "� OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE G—t— <br /> Pacific Gas and Electric Co. VALID =(�csrs TO --'1—Zp/C DRIVEWAYS: <br /> STREET -LI?��r ,(tc, 'DY'- <br /> P.O. BOX 930 AREA S_{rL QUAD <br /> Stockton CA 95201 TYPE <br /> FORMS S/nJvJ, <br /> NOTES <br /> (Z—C)cr) 9yz- <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 3 /i`f S t(C' current M.U.T.C.D. j <br /> Notif. 1 I it l Is 5 I California supplement. <br /> 1 <br /> The undersigned hereby applies for ermission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the .5v tk4-yv side of 'I'OI1 A P/'. <br /> approximately S ee Nle C—/c� Sr/'L— <br /> of f'��+'i E u by pe orming th_e f (lowing work(description of work): <br /> X%sAi'K ti SQ1L)i60 r7<<� ��uv►�y ,¢ '%^9 ��,'S��% s sr°r✓/�� �U�� <br /> Work will commence on or about for approximately / SCJ. 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 /> Signature of Ap icant-Title Date <br /> E:1PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/OB) <br />