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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ��LIr�� OFFICE USE ONLY <br /> To: San Joaquin County JOB# (o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 7. A6 I D <br /> VALID a • 10 TO 1, ,2© d DRIVEWAYS: <br /> Pacific Gas and Electric CO. STREET ES,Pu rwsr ME. <br /> P.O. BOX 930 AREA '!5rtA ' QUAD 1A)5 <br /> Stockton, CA 95201 TYPE -ii-i" i4 <br /> FORMS <br /> NOTES <br /> A <br /> ) ,942--- 1627 <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 J' 014419Z current M.U.T.C.D. <br /> Notif. a California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Wa on <br /> the kaAb ' side of A►r approximately Zd8 feetxle A <br /> of1 6-we-IL by b performing the following work(description of work): <br /> (I <br /> Work will commence on or about IN 10 for approximately I 9>0 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 /> �211 of <br /> 6 L _ <br /> Signature of Applicant-Title Date <br /> SV.WWAMR.PSIEN=ACHMENT POW APPUCAT10KDM [01 <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />