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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date 3 - 1- 11 <br /> OFFICE USE ONLY <br /> To: San Joaquin County FAPN <br /> Z <br /> 'a '(o ONLY <br /> # <br /> Department of Public Works CR#Pacific Gas and Electric Co. TO DRIVEWAYS: <br /> P.O. Box 930 , <br /> AREA M&MEf—q QUAD <br /> Stockton, CA 95201 TYPE `-- <br /> FORMS S <br /> —.S11etsS� - <br /> NOTES �' 2-17 <br /> C 2,05 qqz ZZ-156 <br /> (Area Gode-Telephone Number) <br /> 7Sketched plans may be submitted) <br /> ached sketch. Traffic Control Plan <br /> PM .3 0:�3�C 7� Shall be as per <br /> Notif. � current M.U.T.C.D. <br /> O 5.22225'3 California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on Coun Hi <br /> the A/D2TN side of Ji5AA.16 2L , ty hw g ay Right-of-Way on <br /> Of 14U-S7iA-1 /Z,8 /YIANTEL/�7 approximately -249 feet/R;4 :,qsT <br /> by performing the following work(description of work). <br /> /Ztnc�cE GAS _S'G2uicE To /©��p T 4AJ i;ZD. <br /> GX L.4✓�Tt I3�.CL. J-�pLE aLJL<<Z G�t-S' <br /> S'>2�E7- Tv <br /> BALL /�DLL� DILL 13E �.c! L�tlZT /�,2 �4. <br /> Work will commence on or about 3- � -/1 <br /> for approximately �o 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 /> rr' signature of Applicant•Trtlev 3- - <br /> Date <br /> E'PUB-SV.WKWASTERPSIENCROACMINT PERMR APPL,.K)N-0OC (011M <br />