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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date �'_�"_� o <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# .16J..., <br /> y _ REF# <br /> APN <br /> EXP.DATE $ .�� CR# <br /> Pacific Gas and Electric Co. VALID A T <br /> P.O. BOX 930 STREET j! DRIVEWAYS: <br /> Stockton, CA 95201 TYPES QUAD _ <br /> I i( 6E c , . <br /> FORMS S5 S <br /> NOTES <br /> rea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> PM 3083 S 33.z Shall be as per = <br /> Notif. /0 -/(;S current M.U.T.C.D. <br /> `�.. <br /> California supplement. r " <br /> r. <br /> a w <br /> rn <br /> �C <br /> O <br /> cn <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach the /)=S7— sid �,�,�R �� oach on County Highway Right-of-Way on <br /> of �� approximately 3/80 feet/iile <br /> G1<7 <br /> STO -6AI by performing the following work(description of work): <br /> 12Er�,;:` a ST.f/2�'?' �7�1 l�1 may' x o <br /> � 1/cIS754ZA <br /> J S 2 <br /> Work willcommence on or about <br /> for approximately '910 <br /> I,the undersigned,certify that I am the owner of the respectiveproperty,or am qualified to represent the owner and agree to do the <br /> days. <br /> work described above in accordance with the rules and regulations of n Joaquin County and subject to inspection P and approval. <br /> Signature of Applicant-Title <br /> E:IPU8.SV WKWMERPSIENCROACHMENT PERMIT APPLICATIONjxx (01109) Date <br />