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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 _�� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE v <br /> Pacific Gas and Electric Co. VALID (o "j TO 10 DRIVEWAYS: <br /> STREET "`E5" I I ' <br /> P.O. Box 930 AREA 57"bek-ro 1 QUAD 55 ' <br /> Stockton, CA 95201 TYPE 6u- <br /> FORMS .5e <br /> Z <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 30-7 *7P v'7-'Y current M.U.T.C.D. <br /> Notif. to -4� 9�-Sy�S California supplement. <br /> SERv� �P4r1'v.Y :23.20 S'oUT �Br" ter ,S r, l <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the__ E_ side of 5OCu7"/� $" - approximately_--�/00 __ r"eet�cs�+{e__ st1 _of l0 ''-'r' .5'Jl2ET .gTOci�TD.�I by performing the following work(description of work): <br /> E X tJ�d`E ,t3ELL ./�C�C E c JE.C� L S 1"19JA! /QAJ.�D G°rlT SEIeLl!GC <br /> e /o L�4s ��L�i« TD C�Eio2 A2DI�.c:2TS� FD2 d]E�YIOL./ T/l�.c./ <br /> Work will commence on or about_ - - �U for approximately G - 2S"-,/,O 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 /> ask �;As S- ZY-ID <br /> Signature of Applicant-Title E S7-1 Mn7-09 Date <br /> 1APCB SV.WKW,ASTEPPStENCROAC4.'✓.EP.T KRIMIT APPLICATION.DOC (01103) <br />