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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q-/3- /D OFFICE USE ONLY <br /> To: San Joaquin County JOB# fes REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID `6 TO DRIVEWAYS: <br /> STREET G/Ad , 1 <br /> P.O. Box 930 AREA QUAD ,ltd <br /> Stockton, CA 95201 TYPE <br /> FORMS �artti/ 21 <br /> NOTES <br /> (Zo9) qlz <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 30801,160 current M.U.T.C.D. <br /> Notif. 10ggID6Sy 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, .S'OUTN side of -Zvy Iq[JE. approximately �P.Ptlmla <br /> of 472%f 1<7231,1 by performing the following work(description of work): <br /> �X L c.-,"/-I 7-4E' Vl "el-1- /BOLLS Tv .PL5.**i00E .Si <br /> 1A­70A2K L014 S 0A/ ,OqA-1 <br /> 5 - ;z -�/0 s A16 `l-a -/y. <br /> Work will commence on or about 72: 1L 9>e-/cv 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 /> 'R &ws ?-13 -/D _ <br /> Signature of Applicant-Title E 71mm-oi2 Date <br /> E-APUB-5V.WMMASTER.PSENCROACHMENT PERWi APPUCAT70NDOC (01108) <br />