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APPLICATION FOR ENCROACHIMNT pERMIT <br /> PLEASE PRINT: <br /> Date <br /> To: San Joaquin County OFFICE USE ONLY <br /> Department of Public Works JOB# 73 po <br /> APN 52-x' REF# <br /> Pacific Gas and Electric Co. VA ID ATE a rt cR# <br /> P.O. BOX 930 STREET It TOr t <br /> Stockton; CA 9520v DRIVEWAYS: <br /> AREA TYPE QUAD S� <br /> FORMS <br /> NOTES <br /> (Area Code- I elephone <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTAPPV1CHED SKETCH Traffic Control Plan <br /> Shall NOTI F: i�' _ current M U.T C <br /> < - Californiasupplem en <br /> I t- � <br /> The undersigned hereby applies for permission to excavate,construe <br /> the . <br /> of , side of <br /> p"V t and,/or otherwise encroach on County Highway feeyt t-of-Way on <br /> by performing the following work(descri tion of work): <br /> Work will commence on or about t <br /> 1,the undersigned,certify that I am the owner of the res for approximately___ <br /> work described above in accordance with the rules and regulations r��{ days <br /> respective property,or am qualified to represent the owner and agree to do the <br /> of San Joaquin County and subject to inspection and approval. <br /> Signature of APPlicant- � ' � <br /> Title <br /> ERPSaC'DAC"MEMPERhllTAPPLICATiDkDOC (07/08) Dare <br /> Return permits to: <br /> CCD <br /> P n RnY q�n <br />