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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# - - REF# <br /> APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID „E TO — <br /> P.O. Box 930 STREET A 0* . <br /> f//// <br /> DRIVEWAYS: <br /> AREA <br /> Stockton, CA 95201 TYPE QUAD _ w <br /> FORMS $� <br /> NOTES r <br /> r <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> _ r �; Shall be as per <br /> Notif. , ,� , ; current M.U.T.C.D. <br /> • ±'r' -�-`�� r => California supplement. <br /> RETURN PERM <br /> _ ITS TO: <br /> JOB PROCESS DESK- BLD <br /> 4W Vftw LOW <br /> 81 XTON, CA 96204 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hwa Right-Of-Way <br /> the side of c,-- <br /> of j <;--- - _7 approximately g on <br /> le <br /> by performing the following works descri iti n_f <br /> ,- 9 ( pt on f� work). <br /> C •�' ", :i. '.",t 2"I- <br /> ' <br /> Work will commence on or about r <br /> /I for approximate(„ r <br /> ! -rr.....��...w,y days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and <br /> agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and a <br /> PPr oval. <br /> -51 <br /> Signa re of Applicant-Title a <br /> E.iPU&SV.WK)MASTEP-PSENCROACHMENTPERMITAPP�ICATION.DDC (01j08) _��,� Date <br />