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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 19 -21 -/0 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 6 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE _ <br /> Pacific Gas and Electric Co. VALID t TO _W11 DRIVEWAYS: <br /> STREET -728.q r Aj}, <br /> P.O. Box 930 AREA AeAmfo QUAD N6. ` <br /> Stockton, CA 95201 TYPE , � I� <br /> FORMS <br /> NOTES <br /> X09 9�.Z -/y9�3 <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 30 7951 .3 current M.U.T.C.D. <br /> Notif. /,v Y �,>ylL 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 /3D YN side�of C. J`�)H/anlT'iE'D. approximately 10'70 feeYA4 LJES r <br /> of REaJ.AJ1t/CX RID fir- MPD by performing the following work(description of work): <br /> RL-PL/? y/ST; 12e L STi9r1QA1 722L L Rte/'R�XI fYli9TEL'� .?S�s�T <br /> yF 6,09S /n/3/A/ S 6224Z/4 �.5 /3 Y ?X,"-A/ei-11A1fa <br /> Work will commence on or about /l- / /D 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 /> 4, Ae-da-" - az z;f4s t-.Z I-/D <br /> Signature of Applicant-Title G �I�1YIy�TOf� Date <br /> E:IPU&SV.WKWASTERPSIENCROACHMENTPERMrTAPPLICATION.DOC (01/067 <br />