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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# '�jU05�,-( REF# <br /> Department of Public Works APN _ CR# _ <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID a 09 DRIVEWAYS: <br /> ���,n Ra-,, <br /> P.O. BOX 930 STREET AREA C QUADP� ' <br /> Stockton, CA 95201 TYPE Vii) r�Eu k��s, Fo,P,� <br /> FORMS <br /> NOTES <br /> _(2,0q ) '9.42- 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 j <br /> PM current current M.U.T.C.D. <br /> Notif. l0Z9M34 <br /> California supplement. <br /> The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County H' way Right-of-Way on <br /> the-� side of app=Wetely .feetfmde <br /> ofby performing the following work(description of work): <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 /> o <br /> Signature of Applicant-Title Date <br /> E1,[ ."WWASTERPSIENCROACHMENTPERMITAPPLICATIOMDOC (01108) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />