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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 13'- !S- OFFICE USE ONLY <br /> To: San Joaquin County JOB# <;�� �, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 5 13 ! <br /> Pacific Gas and Electric Co. VALID " i / 0 J S' // DRIVEWAYS: <br /> STREET Z,41 <br /> P.O. BOX 930 AREA �,�, QUAD / - <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> ( rea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 303 213 currentM.U.T.C.D. <br /> Notif. rvS2 lf3:'S 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 SO4,7'N side of Z5. KEz7�L—'I IgAj -.A.!- approximately 1.22S' feet/m4e EAsr <br /> Of- llaE,CL s27c)` by performing the following work(description of work): <br /> malas s£�evocc, <br /> Work will commence on or about_ !!-JG/Ly- 2 v 0� for approximately 90 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 /> Signature of Applicant-Title Date <br /> ElPUS WWKW STERPSIENCROACHMENT PERMIT APPLICATION.D(x (07/0 <br />