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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date tk I 1!o l G� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7� �-(,o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE • l l� <br /> Pacific Gas and Electric Co. VALID //" U TO (o•�•�O DRIVEWAYS: <br /> STREET ,v <br /> P.O. BOX 930 AREA 5rk-^l QUAD,�_ <br /> Stockton CA 95201 TYPE `��� ` <br /> FORMS <br /> NOTES <br /> 1942- 27 <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 5:;'-7401Z7 current M.U.T.C.D. <br /> Notif. Io57eco85 California supplement. <br /> The nd hereby applies for pepission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wa on <br /> the side of approximately— feet/a* or <br /> of by performing the followin work(description of work): <br /> 6wva Ab IT <br /> 2 <br /> Work will commence on or about k l for approximately days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the own erand 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 /> L.WKWASTERPSENCROACHMEMPEPWAPPOCATIORWC (01108) - <br /> Return permits to <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />