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it1aY L L. '� i�Nr� 3 t 735 ur] Ele,tr cr.- 526 2 L' <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT; <br /> Date 5OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE f 2 t3;•r�`} <br /> Pacific Gas and Electric Co. VALJD 7 $ ®� TO 12- 1.09 DRIVEWAYS: <br /> STREET 0,J, <br /> P.O. BOX 930 AREA S^acJcnNQUAD 9s <br /> Stockton, CA 95209 TYPE <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan i <br /> See attached sketch. Shali be as.per j <br /> PM 3070 tleob current M.U.T.C.D. � <br /> Notif. 10WA4C0+ California supplement. <br /> Th e u dersi ned hereby eapoplies f r ermission o excavate,construct and/or otherwise encroach on County Highway Right-of-Wayon <br /> approximately feettimit <br /> of by performing the ollowing work(description of work): <br /> Work will commence on or about____ 51 $ for approximately_ l f (o --days. <br /> I.the undersigned,certify that l 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 ate <br /> [�SKM1hH�'fERP51ENCR'0/+QYdfNYPf.RAA7APPl1U110kDOC WIA1B) _. _ . . ... <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />