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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County FJOB# <br /> Department of Public Works REF# <br /> CR# <br /> EXP. DATE O r O <br /> VALID o TO O i�_ DRIVEWAYS: <br /> P G. &E CO, STREET — , <br /> 4040 WEST LANE AREA : r QUAD <br /> TYPE <br /> STOCKTON, CA 95204 FARMS Nl -- <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 �- Q � current M.U.T.C.D. <br /> Notif. f 9,-, <br /> i <br /> tet, California supplement. <br /> The undersigned hereby applies fo�ermission to excavate,construct and/or otherwise encroach on Coun= Hi hwa Right-of-Wa on <br /> the '�, T � y <br /> -----B-side of ., '` X34 f:< y 9 <br /> of_ _ �'x: approximately e ile <br /> by performing the following work(dedmscripuon of work): <br /> �� � '��- �n"� _ter %�t �, e <` - ''�l�C`l�.� '�• /. ", '°i�? <br /> I <br /> Work will commence on or about_ "<'_ 7 c"' for <br /> approximatelyent_ <br /> es <br /> I,the undersigned, certify that I am the owner of the respective roe days. <br /> work described above in accordance with the rules and regulations of n Joaquin ICoudnty and reprsubject e caner and <br /> dn and approval., <br /> to do the <br /> Signa re of Applicant-'Title <br /> ' Date <br /> EIPU&SV.WKMASTER,PSaCROACFMEWP�MITAPFUCAi CKDOC (0?fOBJ <br />