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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ,2- ,22- if OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1300-5-Z-(,(, REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE 5- 1- 11 <br /> Pacific Gas and Electric Co. VALID 3.1g.. 1 TO DRIVEWAYS: <br /> STREETK*V16AdAA1 W. <br /> P.O. BOX 930 AREA (oyI QUAD ' <br /> Stockton, CA 95201 TYPE " <br /> FORMS Z <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30s3t.t-;-S current M.U.T.C.D. <br /> Notif. IDS.2`3-19,6 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 &007'11 sideof �. 1(Z'0ZE/�7/-r+AJ LA1- approximately 30-s- feet/m4e E4-S7' <br /> Of _e4WIe n/ A?4> Z-OL ! by performing the following work(description of work): <br /> (,,yis s- z�. Lam. <br /> E XC,44c%472F Y 'z Y r3z5LL 1,0465 c)yE2z G/lS /n41A1 "I/u/L) Lu;—oF� <br /> cgAS SE-12tJl nc _ t3,�5LL l fl�LLt iLl t�i44JFl> �4/ZF►✓� <br /> Work will commence on or about 3- y- r! for approximatelyy 2 2-l! 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 /> .- ��.�.c, lg6e -G.qS 2--2-2--11 <br /> Signature of Applicant-Title Date <br /> E.`PUB-SV.WIMIASTER.PSIENCROACHMENT PERMfr APPUCAT10NA0C (01108) <br />