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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2_ .22_ li OFFICE USE ONLY <br /> To: San Joaquin County JOB# �j3oa5� CP REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE S• l• 1I <br /> Pacific Gas and Electric Co. VALID 3• ,I _ TO 1_y',�, j DRIVEWAYS: <br /> P.O. BOX 930 STREETAREA <br /> ,42r�Q.�,� , <br /> Stockton, CA 95201 TYPE QUAD _ 5 # <br /> FORMS <br /> NOTES <br /> .2,o <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> Shall be as per <br /> PM 30 3 -,¢p3 current M.U.T.C.D. <br /> Notif. ID.SZ/v30S 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 r/-/ side of �7'lA2F.9°*LG�j� �i2 <br /> of�/ j y � ,c ,, -�G� approximately 3S/S feet/i*W 4S7- <br /> 41q y✓ ��iZF.42Gc�1 Liz, A 04&TVA1 by performing the following work(description of work): <br /> EXG4Ui47z-- 4j°X- y° BELL 17`DLE DUEfL ��¢S f'y!�}/.[< �iU1� CfiT' vFF SE/Zv7fL� <br /> t/dG.iSC TJ <br /> Work will commence on or about <br /> for approximately 'V-r s-rr 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 /> ZZ 't <br /> Signature or Applicant-Trtle 2 <br /> L Dcfte <br /> E:'PMSV.WNIMASTER.PSIENCROACHMENf PERMIT APPUCA710N.DOC (0711 <br />