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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> DateOFFICE USE ONLY <br /> To: San Joaquin County JOB# 73c)C2 <2- REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 1C"l—Zc>i0 <br /> Pacific Gas and Electric Co. VALIDET �.�t Zbi ' TO I(e 6 > moi( DRIVEWAYS: <br /> h�°t' A"J <br /> P.O. BOX 930 AREA QUAD <br /> Stockton, CA 95201 TYPE o t <br /> FORMS <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 Y/-30i3- tJ current KU.T.C.D. <br /> Notif. ; � �9513 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 401-172-1 side of_GJL13C-t2. /9iJE'.. approximately 1133 feet]+Rk L.J6S7- <br /> of /sJ�9L/CL2 L_eei`=-- aS'Tc)CKTDf4 <br /> by performing the following vrork (descrip+,ion of Work): <br /> Work will commence on or about z;' - /8- /0 for approximately '5'0 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 Date <br /> ....FUF S`;WK`WAST.F R.0 iNC QACHM ENT I'ERM IT A.1UC1TION,1'XK 0i'08) <br />