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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT- <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County [AP <br /> # '�3©o�Z_Cc REF# <br /> Department of Public Works CR# <br /> . DATE 2.I <br /> Pacific Gas and Electric Co. VALID to?'$.IR TO _2- l T. li DRIVEWAYS: <br /> P.O. BOX 930 STREET 9i',o,QA ,,a Ave <br /> AREA hoc_ ic� QUAD <br /> Stockton, CA 95201 TYPE _ o�� <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> 7S�ee <br /> (Detailed plans may be submitted) <br /> attached sketch. Traffic Control Plan <br /> M 3���9� Shall be as per <br /> current M.U.T.C.D. <br /> Notif. 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 w�s7- side of 1�c�2llt�y approximately J3 <br /> of .miry ,q � "'I�TD�t` ,by performing the following work(description of work): <br /> )� <br /> A ,t �z':� L-).a� TJ <br /> 60AJZ5 1..2 4) - <br /> �nc.a ,! <br /> Work will commence on or about <br /> 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 /> &ignatAreofpplicant�-Tltl'e� 2 <br /> Alj'1'1 n'TOR Date <br /> E:IPU&SV.WNIMASTERPSIENCROACHMENT PERMIT APPUCATION.DOC (D110% <br />