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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �', v� OFFICE USE ONLY <br /> To: San Joaquin County JOB# -72_x Z 4, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE j Z•j •O <br /> Pacific Gas and Electric Co. VALID r' 'OF TO /Z-1, _ DRIVEWAYS: <br /> P.O. BOX 930 STREET <br /> AREA <br /> Stockton, CA 95201 TYPE — o ' <br /> FORMS �s v <br /> NOTES " <br /> � 1 `942- «27 <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 ?D`-7! , currentM.U.T.C.D. i <br /> Notif. (ra37�7Zg� California supplement. j <br /> The undersigned hereby applies for p r ission to a cavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> ofe side of �GI � I approximately I©® feet/ e� � — <br /> by performing the following work(description of work): <br /> on <br /> Work will commence on or about 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> of Applicant-Title ate <br /> t.?Sign,ature <br /> NCROACHMENT PERMIT APPUCATION.DO: (07/08) <br />