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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# lje5t6Z-.t'. REF# <br /> Department of Public Works APN 1 0 _ CR# <br /> EXP.DATE 12. 1 10 , <br /> Pacific Gas and Electric Co. VALID is ,6 TO 97- i6 DRIVEWAYS: <br /> STREET _ <br /> P.U. Box 930 AREA ---9rr4,Jcr4rl QUAD ' <br /> Stockton, CA 95201 TYPE �c ` <br /> FORMS <br /> NOTES <br /> (201 ) <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/3,.21//6 current M.U.T.C.D. <br /> Notif. 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 .SDuT/l side of /2 �� .STX4257approximately 2 S 3 feet/4�e- L.JEST <br /> of " !3 " STiP1567' S7204CfDi<1 by performing the following work(description of work): <br /> 'CX CEJ L/4 T"2y1 �L L 1-101—E' ZV /-7 <br /> Work will commence on or about_ '�-'/S—/o 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 /> Signature of Applicant-Title -S7-1 n7bg Date, <br /> NPU&SV.VdKHASTERPSIENCROACHMENT PERMIT APPUCATION.000 (01108) <br />