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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��Z7�b� OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID 8• Q O TO o?•!✓.,fes DRIVEWAYS: <br /> STREET il/�Li► ,ley , <br /> P.O. BOX 930 AREA aa,Ern„/ QUAD /((.3 ` <br /> Stockton, CA 95201 TYPE mil 14 e ;t gN-,G <br /> FORMS Tye. K'-29 <br /> NOTES <br /> 942- 1627 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan i <br /> See attached sketch. Shall be as per j <br /> PMcurrent M.U.T.C.D. <br /> Natif. � � Qjl` I California supplement. <br /> The undersignpd hereby applies f r permissio�xcavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of jJ approximately 170 feeth* <br /> of by performing the following work(desAn cnpt�ion ofwork): <br /> 4n tri o I <br /> Work will commence on or about for approximately days. <br /> i�T <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 /> 'he i1h "-'v- A <br /> Signature of Applicant-Title I tate <br /> 8-SV.WKI%VMERPS\ENCROACH.t1ENr PERmrAPPLICATiON.DDC 01108) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />