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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3G1Xa"Io_( REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE f.fr, ,2-016 <br /> Pacific Gas and Electric Co. VALID ,2610 TO Z15%?.014� DRIVEWAYS: <br /> P.O. Box 930 STREET 51.E Sr <br /> AREA f:5r-Qck;MtJ QUAD FfS <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> /(Area Code-Telephone Number) <br /> 7See <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> ached sketch. Shall be as per <br /> PM 7'- current M.U.T.C.D. <br /> Notif. <br /> California supplement. <br /> The undersigned hereby applies 1`oermission to excavate,construct and/or otherwise encroach on Coin Highway Right-of-Way on <br /> the T side of_ `.c $��:%" approximately �' fe mile <br /> by performing the following work(description of work): <br /> , <br /> Work will commence on or about ��- <br /> for approximately. days. <br /> T <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 /> Signa ure of Applicant-Title `f <br /> 'Date <br /> SNUB-SV.WKIMASTER.PSIENCROACFiMENTPERMITAPPLICAT10N.DDC <br />