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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 30 - IC; OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID TODRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA I QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Area&o—deTelephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> Sketch <br /> attached sketch. Shall be as per <br /> PM :Z, <br /> PM 3 0758137,Y current M.U.T.C.D. <br /> Notif. ./,04,/ Zorn 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- AIDIF774 —side of p_0 . approximately 1 <br /> of 7-/Zt;,�f y 13 L.L/L) —18'?�.5 -feat/mile U)697' <br /> 77?;�e_ by performing the following work(description of work): <br /> Ex CA LJ14 7 C_ HELL 1404-,C- _AJ R19LA ,*"EAJ7- IqAJL 7_12,!!5AJC_H 30 r <br /> Work will commence on or about_ 7f0rap�roxmale�ly � <br /> 1D--days. <br /> 1,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 /> 4 _ <br /> Z;)qs I Q <br /> fs Signature of Applicant-Title Z—Z_-Sri M,470- 12 Date <br /> E!PUB SV.WKMASTER PStENCROACHW%T PERMIT APPLICATION.DOC (01/08) <br />