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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date' '�,�(� y� S <br /> OFFICE USE ONLY <br /> i <br /> To: San Joaquin County JOB# �:2Zd t(D 6 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID 5- ,/ 2C2Z� TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET c' <br /> P.O. BOX 9.30 AREA QUAD('r_ <br /> Stockton, CA 95201 TYPE �vj�� c��a I TW-_v.G l,. <br /> FORMS <br /> NOTES <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 31'1ygo/- " current M.U.T.C.D. j <br /> Notif. California supplement. <br /> I <br /> /OD G,#A4)e 7&. ('_"o u h 12a,.4� P/-Cj PC`s, <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High Right-of-Way on <br /> the So t14 <br /> k-\ side of L t} T�/� !�✓ approximately ��—fe mile E. � <br /> of Pe/A-wg 1241 , 4 /•/ _,by performin the following work(description of work): <br /> C.�t/�f`O O`tD ,r S, /3�l/, ,- %!lJ '-9 A�� <br /> Work will commence on or about // s _for approximately 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 ccordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signat ` pplicant-Title Date <br /> E:1PUB-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br />