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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID -zo-tI TO DRIVEWAYS: <br /> STREET A'4e <br /> P.O. BOX 930 AREA QUAD FS <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (20q ) qyz - /y93 <br /> (Area ode-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3v33,rY51-/ current M.U.T.C.D. <br /> Notif. /0520S±339 California 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 art SE <br /> T side of S. ���c�ES eqeJ . approximately 912 ` feet/+#le nlotZf7d <br /> of—e41" by performing the following work(description of work): <br /> i?CD'zf <br /> To 90.3 S. 619- .>C.S <br /> Work will commence on or about zl. - .2for approximately 14�0 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 Date <br /> E:IPUB-SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />