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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /D - /-zo OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works AN _ CR# <br /> EXP. DATE ; ® /a <br /> Pacific Gas and Electric Co. VALID al 4fio TO i It DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA at QUAD t9f <br /> E P <br /> .Stockton, CA 95201 ORMS D <br /> NOTES <br /> 204 9Y2 <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 y13116 3`I. current M.U.T.C.D. <br /> Notif. 1oy;t;?Z1.2p• 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_ LJEST side of M,12' /��T'/�u�2 3Z __approximately OPPDS>TE #e� <br /> of_ 4DR1219/A/E' 40,,E 7-RAC--1-,by performing the following work(description of work): <br /> Z X G.i4 OA 7';E S/'r- q ` BELL I-1,04E D[!E/Z GAS M14W A Gt 4nt ob E- M <br /> 117AIAl /9A/A XAISrraLL F2lqr»E GoLjg-)Z xcka A TEST" -SrAr10AJ- <br /> Work will commence on or about AS -- 067-- 2ol0 for approximately 90 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"IL P.ri✓y - '81Z Z;f4s /d-1-/d <br /> Signature of Applicant-Title -S7'jMn7-09 Date <br /> E1PUB-S\'.WKUTASTER.PSENCROACNMENTPERMRAPPLICATION.DOC (01/am <br />