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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# }� _(� REF# <br /> Department of Public Works, APN CR# <br /> EXP. DATE 7 lS 2aJ0 <br /> Pacific Gas and Electric Co. VALID q' yo o ' TO y zojo DRIVEWAYS: <br /> P.O. Box 930 STREET &,1 <br /> AREA --roe-&mtJ QUAD 1 <br /> Stockton, CA 95201 TYPE �o <br /> FORMS <br /> NOTES ' <br /> (A a Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan c <br /> See attached sketch. Shall be as per <br /> PM 1 fN current M.U.T.C.D. <br /> Notif. L; 4 Q California supplement. �' <br /> E3 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on Coynty Highway Right-of-Way on <br /> the side of ,",�"; , , <br /> -- approximately Ze , , <br /> J 1 by�performin)the following work escription of work): <br /> t� :', vd?'i?. ✓'R !',�1.•"r' r .✓`� b'.'ti �� "J�r�.�- .'' Gig - <br /> y <br /> <'b <br /> Work will commence on or about_ 'a �% for approximately days. <br /> 1,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 dYApplicant-Title to <br /> E1P'J6 SV.WKW9ASTE R.PSIENCROACMENi PERMIT APPLICATICN.DOC (01/08) <br />