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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1? -10 OFFICE USE ONLY <br /> To: San Joaquin County JOB# y�'9059-G, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE y <br /> Pacific Gas and Electric Co. VALID 0 DRIVEWAYS: <br /> STREET 1r <br /> P.O. Box 930 AREA Zy rpw,,. QUAD Ar/ <br /> Stockton, CA 95201 TYPE rtsa rte <br /> FORMS <br /> NOTES <br /> 2 D <br /> (Ar 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&1277_7current M.U.T.C.D. <br /> Notif. California supplement. <br /> �1�1Lt4GJwaV�S� <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of— approximately feeUmile <br /> of by performing the following work(description of work): <br /> ..Z"A <br /> T/E E x Is i�nl� �i4S /�'I.4i.vS J RIA1 -SCO !ZL�1_ AIV D <br /> Ta /� xJC[J ��9s rYl�i c/ 13,!5*1uZ, _D 744z_,,�6 1.rtl /-/..)Y L'6. WSTi4LL <br /> Ll�S I'�/�i,',/S t3 y DPEiV �R,6UZ14/.JfG, .2EI'L.4f� LAS SF�2r1iCE Tv <br /> 2 L 1 Ps c/AS D R1Z 2 Y J3d,P, ND eQt_1A.17_V P�lr1Cn-��ivT �S <br /> Ex Pee TEv Ta R'F v tsfURBE8. <br /> Work will commence on or about 9- 2-lo for approximately 9t3 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 SrlM,07Of2 Date <br /> E:':o�JB SV.WM.M1fASTERPS�ENGROA-HMENT?FRA1;:APP'ICAT:On;,ppC (01/D8) <br />