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APPLICATION FOR ENCROACHMENT P <br /> PLEASE PRINT: P� 2:36 <br /> Date to OFFICE USE Y,`%::., , <br /> To: San Joaquin County JOB# fj�?// REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE JOO/. 0 <br /> Pacific Gas and-Electric Co. VALID • 1910 TO -1.-+a D/0 DRIVEWAYS: <br /> STREET Ag, <br /> P.O. BOX 930 AREA QUAD 05 ` <br /> Stockton, CA 95201 TYPE AAaori <br /> FORMS <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 ?�V-(o &54 current M.U.T.C.D. <br /> Notif. 1C46t6(.VC . California supplement. <br /> The undersi ned hereby applies f missio to e�cavate,construct and/or otherwise encroach on County Highway Right-of.-Way on <br /> the _side of approximately �& feethnitr : <br /> of �441VW121) b performing th fol owin w rk(description of work): <br /> Work will commence on or about. 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 tDate <br /> &SV.WKWMERPSIEN=AWMEM PEWa APPUCATIOKWC folj% <br /> Return permits to'. <br /> CCD <br /> P.O. Box 930 <br /> q+nrL-tnn (-A Qx;,)ni_nQ An <br />