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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> l' <br /> Date Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 935, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 2•15--f1) <br /> Pacific Gas and Electric Co. <br /> VALID (.4_a TO 2•f5•/b DRIVEWAYS: <br /> STREET Gbh <br /> P.O. Box 930 AREA FsMWc I MUAD•t5r,- ` <br /> Stockton, CA 95201 TYPE o� ' <br /> FORMS SF5/, AVt A.. 2,1? <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. w' t, California supplement. <br /> The undersigned hereby appliesfor er fission tg excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the n/lrf�"z side of � / � approximatelyrescription <br /> n3ite-L�L� <br /> of i�T,� X51-' roc ) c rr1 by performing the following work of work): <br /> 6 5, ice, r <br /> Work will commence on or about for approximately zc7 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:IPUB&SVWK�MASTERPSIENCROACHMENTP;RMITAPPIICATION.DCC (0808) <br />