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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date t` j /� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730052REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE rd 1S-zolza <br /> Pacific Gas and Electric Co. VALID 2.1. TOIS•Z1016 DRIVEWAYS: <br /> STREETU/�1/ �1 • <br /> P.O. BOX 930 AREA , QUAD fS <br /> Stockton, CA 95201 TYPE <br /> FORMS , <br /> NOTES <br /> 1942- 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 � j2Z current M.U.T.C.D. <br /> Notif.(oCalifornia supplement. <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of tAVin 4approximately 1(29 feet/aft G <br /> Of TK-nc by performing the following work(description of work): <br /> Nlrt n <br /> ate 1�- n XUP j2 <br /> Work will commence on or about ZIt/10 for approximately I 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 /> 3-0ou' )U 01 <br /> Signature of Applicant-Title Date <br /> t'SV.WKNASTEP PSIENCROACHM.EUr PERWTAPPLICATIONAOC (01/OM <br /> Return permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />