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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Y <br /> Date ��- - .� OFFICE USE ONLY <br /> To: San Joaquin County JOB# '130©Sf2.- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 5- 1-2c.(k <br /> Pacific Gas and Electric Co. VALID 2 21.2&,)TO 9--f-�1. DRIVEWAYS: <br /> STREET t ppV&A^ St <br /> P.O. Box 930 AREA SttacftovL QUAD t*,%S <br /> TYPE I <br /> Stockton, CA 95201 ARMS SS�4 k) b� R 2� <br /> NOTES <br /> a/ <br /> (Afea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3o32,��3;z- current M.U.T.C.D. <br /> Notif. �, � 535. 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 LE19S 7 side of S. Ez- 4102/-X» .Si. approximately `� feet/ file sOL/Ti�f <br /> of 1�v.2L 21�. r"R�n/cr eglm& by performing the following work(description of work): <br /> �t.IT=J.rcr`- ✓�✓�� .,SL�'r�'d.�d,�� . � °�'L�'.'�(Z e�d2�d��.2.��' .G"r.�,tZ .'.�c iB'1��.P 6'_'®r�,t.1 <br /> Work will commence on or about =,- 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 � � j,�To12 Date <br /> E1PN&SV.WKMASTEPPSENCROACHMENTPERMrf APPLICATION.DOC (01!007 <br />