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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ' OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1300;�--4y REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE t k.l •o <br /> Pacific Gas and Electric Co. VALID Q. j ,a9 TO k\- \. pq DRIVEWAYS: <br /> STREET '"'o QL A ce— -3;7 <br /> P.O. BOX 930 AREA -5::rroc1c7zWQUAD ' <br /> Stockton, CA 95201 TYPE �� ,, <br /> FORMS �/,► / --2 <br /> NOTES <br /> (2Pq ) `942- 162-7 <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 307'00 Z'q! current M.U.T.C.D. <br /> Notif. `"2)72P)n2t,7 California supplement. <br /> The undersig d hereby applies for permission to ex avate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the G side of approximately 1�8 feetla*e <br /> Of ,by performing the following work(description of work): <br /> o-n <br /> b : <br /> Work will commence on or about for approximately o 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 Applicant-Title Date <br /> LSV.WKWASTER.PSkENCR0ACHM.ENT PERMIT APPLICATION.DOC (01A8J <br />