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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date a✓ ! OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF <br /> Department of Public Works APN CR# <br /> EXP. DATE V-6/2 <br /> Pacific Gas and Electric Co. VALID TO DRIVEWAYS: <br /> STREET sc1 <br /> P.O. Box 930 AREA Liv / QUAD ASK <br /> Stockton, CA 95201 TYPE amu <br /> FORMS 3$y <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 3 v -�7 9S!�?°` current M.U.T.C.D. <br /> Notif. California supplement. <br /> SCcr AF,7-�9 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 6:n S T' side of Aq[.,;E• approximately /2 / feeYP;4e Soul <br /> of by performing the following work(description of work): <br /> Cur- Dry= Z,.A45 L,-'✓,E /v7- AJ 2 rO <br /> EX z-A 7"L T' �2�i9 DLEfL ��45 .�aio✓�/ <br /> Work will commence on or about - 2 - !J for approximatelydays. <br /> I, the undersianed, 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 /> 0.4"ff <br /> Signature of Applicant-Title E-S7-1 Mn7-012 Date <br /> LIPUB-SVA%'KWA51ER.PS\ENCROACHMEM PERMIT APP"JCATION.000 101108) <br />