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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730 .2,—� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /X 3,p Id <br /> Pacific Gas and Electric Co. VALID TOS'�l�c -- i DRIVEWAYS: <br /> STREET Gwsc'Y A4Q'„ <br /> P.C. Box 930 AREA 6e v-4UAD <br /> Stockton, CA 95201 TYPE tti ud�� <br /> FORMS R21 SS ILA ew <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 507 - Z,621 current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High�way Right-of-Way on <br /> the fad side of ��,il< approximatelyi 6 -' teet�riite 4zlzz7'-� <br /> }- . ,by performing the following work(des ription of work): <br /> Work will commence on or about_ ' G f 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:IPUB-SV.WNIMASTER.PSIENCROACHMENT PERMIT APPLICATION OOC (01108) <br />