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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:�1 <br /> Date t /'D OFFICE USE ONLY <br /> To: San Joaquin County JOB ria REF r <br /> Department of Public Work,,; APN r CR r <br /> EXP. DATE a �o <br /> Pacific Gas and Electric Co. VALID 1b T` TO t Eu _ DRIVEWAYS: <br /> STREET 4aulxe RD. <br /> P.O. Box 930 AREA -fl*,Y QUAD S? <br /> Stockton, CA 95201 TYPE I-r <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan N� <br /> See attached sketch. Shall be as per -- <br /> PM 3o??y,5'9j current M.U.T.C.D. <br /> Notif. /og6l. 2gYfq California supplement. <br /> Fl, cj�i <br /> 917,12 -0 17,')tZ <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SDUTh` side of approximately ?DD _feet/f+{e 6AS7' <br /> of 7",Q19G V , by performing the following work(description of work): <br /> 7",e,!EA1L'1-1 2S FT. ::Z2"n1 L.2i9Ss /�f2�.�t �i✓d T 1cr.4i L /��9LJ /?�lDt�GJT�Z� <br /> cr�P14cC 172 � <br /> Work will commence on or about for approximately 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 <br /> Signature of Applicant-Title E-S 7-1 yy nVoI2 Date <br /> E 1PUB-SVVKMASIEP PMENCROACHMENT PERMIT APP-KATION.000 (01,02) <br />