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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10 -19-10 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7z�-6 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATEIAV— <br /> Pacific Gas and Electric Co. STUD /To DRIVEWAYS: <br /> STREET l41,$ <br /> P.O. Box 930 AREA QUAD—..�.'L� <br /> Stockton, CA 95201 TYPE t <br /> FORMS Z <br /> NOTES <br /> (Afea Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> SES 1972-4c14ED S/«TGN_ Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30?95ooY current M.U.T.C.D. <br /> Notif. to Y780?,62 California supplement. <br /> DUlAL/oA7-Z <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the .BOUT/-/ side of U4-RAIA41S PC). approximately 1135' fee�J4*4e 6JE5r <br /> of J-iILHL.iA°/ .33 T1Zr4G y by performing the following work(description of work): <br /> ALL LJ09d< TO 86 L OAILC YAl t�i2T" A,2,6 tq <br /> SEE/0 _ &-7ELL /+610095 AAL 72,5Ai V 30 ' : '2an1 AoLz to WeLL. <br /> Work will commence on or about /- /- /D for approximately D _ 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 /> 004..2 ask Z;As ✓©--1`t-lo <br /> Signature of Applicant-Title -S1-1mnVD12 Date <br /> E:%PUB-SVV,-KMASTEP PSIENCROACHMEM PER%111 APP,ICATION.DOC (01/095) <br />