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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4� -- '7 w �- OFFICE USE ONLY <br /> To: San Joaquin County FAP <br /> B# �3d4so�-G� REF <br /> Department of Public Works N CR r <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID J�3, <br /> • � _ TO to DRIVEWAYS: <br /> P.O. Box 930 STREET ,� gy- <br /> AREA STac4-,-Z;„/ QUAD <br /> — <br /> Stockton, CA 95201 TYPE -9AZI <br /> FORMS S C,..s✓ , Z9 <br /> NOTES <br /> i <br /> it <br /> C <br /> 0 q - <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 `�:- ? p " 7�'.° current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High ay Right-of-Way on <br /> the E/3 e side of___ � , _�i approximately j.S` feet/*+le <br /> of n'J,9i�> GJ`Y ts- roc,t'cT?1,c1 by performing the following work(description of work): <br /> Work will commence on or about__ A-.3 /J for approximately <br /> 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 E-S7-jMi96T0f2 Date <br /> E*TUB&SV.WKLMAST-ER-PSIENCROACHMLMP:RhiIi APPLLA?IC,.N.DCC (()1/08) <br />