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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3 12 t t o OFFICE USE ONLY <br /> To: San Joaquin County JOB# ?3 - REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID TO / rI DRIVEWAYS: <br /> P.O. Box 930 STREET <br /> AREA0l&4 QUAD S ' <br /> Stockton, CA 95201 TYPE1 <br /> FORMS ,arts ,G. j <br /> NOTES <br /> `!N2- <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 y 114 5,11 z3 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 EA S-r side of IZ o B t t`l pA606 approximately f 4 S feet/�le &5 o a--t4 <br /> of C!��lZ o K _ R 1 , _5 TO c LKTIC t by performing the following work(description of work): <br /> Gr4Tt-f c�t C t ?Ca 3Z1< ar sn3 c,S) Q►J �� /ti 1 t n <br /> MAN -N 3 T TCa FULLn <br /> Work will commence on or about_ 3- 1'}- t I for approximately cv wL pc..4rr-4<<�> 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 /> iz1 t i <br /> Signature of Applicant-Title Date <br /> E:IPU&SV.WKWMERPSIENCRDACNMENTPMMTAPPLICATION.DOC (07)08) <br />