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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date sDL <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works [AREA <br /> rj3j��_� REF# <br /> CR# <br /> S•• - <br /> Pacific Gas and-Electric Co. tam TO DRIVEWAYS: <br /> P.O. BOX 930 _L.a sh% to , <br /> Stockton, CA 95201 QUAD Sym <br /> FORMS <br /> Ww P--Z9 <br /> NOTES <br /> �?� ) '9 2- 1162 <br /> (Area Code-Telephone Number) <br /> 7See <br /> ed plans may be submitted) <br /> ached sketch. Traffic Control Plan <br /> `�°.Xo g Shall be as per <br /> current M.U.T.C.D. <br /> Notif. `1038 $3 Z <br /> California supplement. <br /> ! <br /> The unders'gned hereby applies for ermis 'on to ex avate, construct and/or otherwise encroach on Co <br /> the side of County Highway Right-of-Way n <br /> of approximately a __feet/ <br /> by pe orming the following work(description f work): <br /> Work will commence on or <br /> for approximately 1� <br /> I,the undersigned,certify that I am the owner of the respective ro days. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to <br /> P p perty,or am qualified to represent the owner and.agree to do the <br /> J inspection and approval. <br /> #1 <br /> IUtu <br /> 1 }1 Signature of Applicant-Title 7 <br /> EMl/&SV.WnUASTEP PSIENCROACHMENTPERMIT APPLICATION.DDC ate <br /> (07AI8) <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />