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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ ��.. �_ �® <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works �"� REF <br /> APN CRS -- <br /> EXP. DATE 3 <br /> a <br /> Pacific Gas and Electric Co. VALID �A ,0 <br /> STREET DRIVEWAYS: <br /> P.O. Box 930 �G� -Bj.vD, <br /> Stockton, CA 95201 EA <br /> TYPE QUAD <br /> t.t 4-4a►.�� <br /> FORMS '� � <br /> NOTES <br /> OR <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may b im <br /> e ss abitted) <br /> See attached sketch. Traffic Control Plan <br /> Shall be as per <br /> PM 2031z13,0 current M.U,T.C.D. <br /> Notif. ®p yg3cCalifornia supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 7- <br /> � ,]21�Cy SL[JLl <br /> of ei��,cs,c ,en ICY approximately_ Yp0 feet/.R l _,Sp�Zl <br /> by performing the following work(description of work): <br /> 19 r rh 14 <br /> U14&.el r1o2 �Tim O 6257 <br /> Work will commence on or about_ a_ Zy_ ��� --- <br /> 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 /> Signature of Applicant-Title <br /> E-S7-1M)WU2 Date <br /> E:IPDBSV.WKWgSTERPSENCRCACHMEM rERMR AFPLICA710N.DCC (OLD6 <br />