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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> DateL4? OFFICE USE ONLY <br /> t <br /> To: San Joaquin County JOB# '13oDSZ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE IZ• t.'0'7 <br /> Pacific Gas and Electric Co. VALID N o _ TO t2• j.d4 DRIVEWAYS: <br /> STREET A RD, <br /> P.O. BOX 930 AREA 4�Mep QUAD le <br /> Stockton, CA 95201 TYPE �LL x6� # &056 <br /> FORMS /Le/w, rP-2'p <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 current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned hereby applies or permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the _side ofLl x� —approximately 1 D feet/Rk or <br /> of y performing the following work(description of work): <br /> Work will commence on or about 511 t70,9for 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 accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> Signature of Applicant-Title Date <br /> �YSVNKWASTEPLPSkENCROACHMENT PERMIT APPUCATION.DOC (01MB) <br />