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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> �, <br /> Date )-/z�� FI <br /> F <br /> 0 CE USE ONLY <br /> To: San Joaquin County JOB# f, jo2-gyp REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 2•14--/0 <br /> Pacific Gas and Electric Co. VALID a9 TO DRIVEWAYS: <br /> P.O. Box 930 AREAET 54el-4w.4f ✓QUAD <br /> Stockton, CA 95201 TYPE 6 ` <br /> FORMS f✓ L <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 , current M.U.T.C.D. <br /> Notif. 104,&774 California supplement. <br /> The undersigned herebyapplies for permission to exca ate, construct and/or otherwise encroach on C unt Hi h <br /> PP P 9 y g wa Right of Way on <br /> the ��G' <br /> side of v �� <br /> E approximatelyfC"eet/�ile���� <br /> of a a by performing the following work(description of work): <br /> X'I- AVI <br /> � <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 /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKWiASTER.PS\ENCROACHMENT PERMIT APPLICATION.00C (07178) <br /> I <br />