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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date � OFFICE USE ONLY <br /> To: San Joaquin County JOB# "_1,3455i . REF# <br /> Department of Public:Works APN CR# <br /> EXP.DATE • Js': <br /> Pacific Gas and Electric Co. VALID 7. 13•oq TO .15.Oq DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA 1r kw QUAD ,t,6 <br /> Stockton, CA 95201 TYPE <br /> FORMS l✓w 42- <br /> NOTES <br /> � 1 2- 1627 <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 current M.U.T.C.D. <br /> Notif. <br /> 10,�*779M California supplement. <br /> i <br /> The u dersigned hereby applies fpr permission excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the of f �� r�e o� � µ �� approximately_ Z1 ——__feet/mi1e <br /> by performing the following work(description of work): <br /> Work will commence on or about for approximately J days. <br /> Y <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 <br /> ate <br /> 8-SV.WKWIAS7ER.PSIENCROACHMENT PERMIT APPLICATION.DOC pjoa) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />