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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 51 �I�� OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE 2 `j <br /> Pacific Gas and Electric Co. VALID s Zco op TO , 0 _ DRIVEWAYS: <br /> STREET E EtS' 2 1Zp, <br /> P.O. Box 930 AREA 5`F-OckTO QUAD S'F- ` <br /> Stockton, CA 95201 TYPE 361L #oma — <br /> FORMS 7 � <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 307 I bVeP45 current M.U.T.C.D. <br /> Notif. (o3, California supplement. <br /> The undersigned hereby applie for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 2h&b <br /> side of approximately feet/ <br /> of <br /> by performing the following work(description of work): <br /> Work will commence on or about for approximately 11 2& 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 /> �-SV.WKIMASTERPSENCROACHMENTPEFdAITAPPUCKnOMDOC (01/08) <br />