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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730b a-(, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE t !� <br /> Pacific Gas and Electric Co. VALID 2•t Yo TO A t 110 DRIVEWAYS: <br /> STREET 99 9-W <br /> P.O. Box 930 AREA QUAD <br /> Stockton, CA 95201 TYPE B6 LL 14oL6S �Z <br /> FORMS <br /> NOTES T <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 3071-/36;1,0 current M.U.T.C.D. <br /> Notif. California supplement. <br /> Is.JO�/� LOC�4T"/�fl: <br /> S22,61 otJ. MO Y 91F/ S7 nL AO tJ <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the LJCST side of NLJ`/ X19 F'00A17_A4E RL. approximately ?20 feetfta� ,-VOWIN <br /> of /_71. /'r1Nl0.'019Y Z�APTf2 �eE _ S'TUGKTvcl by performing the following nrork(description of work) <br /> �XC�1tlt9TE AEL_Z_ A&X,c Tv rJ,9r,41_L Alead &,-AS �SEkUiGc, <br /> 1CC�9[/�I TL BELL lv,OLz Tv eL17_ GOFF 0L_,LA <br /> _17LL 4JDIZx rD R—I'* voArE rtr L>i127" <br /> Work will commence on or about_ 2 N-1nn11 - '10 for approximately 90 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 /> 41-1.2 -10 <br /> Signature of Applicant-Title E S7-1 M y9,-Tp� Date <br /> E:1PUB-SV.WKIMA,�iERPStENCROACHMENTPERMf7APF-LICATION.DOC (01/06) <br />