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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: aa rr <br /> Date ��-I � � 7 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> w �-t."4-5--(�REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID mar-_7C0 - .� DRIVEWAYS: <br /> STREET ' <br /> P.O. SOX 930 AREA -IC',,QUAD _ C, <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> 70 .7. l031211 �� <br /> (Area Code-Telephone Number) �� En:CCr�tH L� V-M tT <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. <br /> California supplement. <br /> -heund rsi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> le 4 side of approximately see tke4-c(., ' feet/mile Seer <br /> f by performing the following work(description of work): <br /> h /2 v�Rr Ga <br /> CA <br /> La ak,d <br /> 'ork will commence on or about ( - for approximately vis• days. <br /> 'he undersigned,certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> )rk described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> S10jure of A scant-Title cF � � - ate <br /> 3-SV.WKWiASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />