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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County [APN <br /> OB# "?x®052.- , REF# <br /> Department of Public Works _ CR# <br /> EXP. DATE a�j <br /> VALID f8 O TO / 07 DRIVEWAYS: <br /> P.G. &E. CO. STREET � <br /> 4040 WEST LANE AREA �r ,,, QUAD E <br /> TYPE <br /> ll } <br /> STOCR"TON, CA 95204 FORMS <br /> NOTES <br /> r Z� 1�l <br /> (Area Code-Telephone Number) <br /> FNotif. <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> ached sketch. Shall be as per <br /> 07!17-34 currentM.U.T.C.D. <br /> California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Coo Highway Right-of--Way on <br /> the �,res7- side of�/S f,1u.y, 99 �,q�,jf.�� Rp , approximately ee rhe <br /> of �b/4 �4 e 1, o r o f �� � <br /> � '` _, b, p ..o m.ng ol;owing work, e�cription of work): <br /> !�g eku 4,c, 6x, VIVO, <br /> rQ IC <br /> • R " G u 0114#1 e- e- <br /> Work will commence on or about_ <br /> 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 a ove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> as 4 �S- <br /> Sig ture of Applicant-Title <br /> ate <br /> E1PUB'SV.WKIMASTE2PSIENCROACHMEYT PERMIT APPLICATION-DOC {01/00) <br />