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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date j��f rte_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# .-(p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VAUD 10.18.09 To 4• t5•of DRIVEWAYS: <br /> STREETc�� �e <br /> P.O. Box 930 AREA f-�A QUAD ' saw <br /> Stockton, CA 95201 TYPE js && � <br /> FORMS <br /> NOTES <br /> (2--Cq 2- 162-7 <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 -i5p7 current M.U.T.C.D. <br /> Notif. �b2Cj0(v California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of:-Way on <br /> the I . side of �ri��' �G� _� approximately. I' i feet/m4e <br /> of by performing the following work(description of work): <br /> Work will commence on or about D 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� htty • �Q� � p �, � <br /> SignatCure of Applicant-Title Date <br /> JBSV.WMSASER.PSIENCRDACMvtENTPSWAPPUrA710NA0C toilM <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />