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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date , <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73065' _ REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE iZ. 1.0!2 <br /> Pacific Gas and Electric Co. VALID 5, ,.c>9 TO i7. I.09 DRIVEWAYS: <br /> P.O. BOX 930 STREET ItF., <br /> Stockton, CA 95201 nP 8 --� QUAD F5 <br /> FORMSa/WWc� <br /> NOTES <br /> (2PI ) '94 2- 162 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> Shall be as per <br /> PMvc-7 -74a-' current M.U.T.C.D. <br /> Notif. I D� <br /> California supplement. <br /> i <br /> r. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way <br /> the side of�~ 9 y ht- - <br /> g of Way on <br /> of �K �' approximately '47_____feet/aft <br /> k Yto '. U --� by performing the following work(description of work): <br /> I Z21 42 �' ��j� f� r <br /> Work will commence on or aboutfor approximately (I- ,,c79 <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree days. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> PP <br /> Signature of Applicant-Title ------`� � <br /> Date <br /> &$V.WKAAASTERPWNCROACHMENTPERWAPPLICATIOPIDOC (01MB) <br />