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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date S-2--2nel OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73406c REF# _ <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID & 1,3 // T /� J/ DRIVEWAYS: <br /> P.O. BOX 930 AREAET o- QUAD K_ ' <br /> Stockton, CA 95201 TYPE a <br /> FORMS ,,aq4 �Z� <br /> NOTES `�`�� <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 3v13Y current M.U.T.C.D. <br /> Notif. Zp.,r-,?,zgc�,�1� 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_4S,04/7/'/ side of M47' ZI-9 L,J approximately_,�7 feet/ ile L.�EST <br /> of D/fK •�r� rl .rF STO-*- 7KMt1 , by performing the following work(description of work): <br /> E x G4 TE' V`x Y' ffv,� .0v� 4AS IWIgI .1 �r1T DFF GLt� <br /> L L /��.CK .2S TT P .��.-Yr.� Zc <br /> Work will commence on or about_ /3—.T�/w/rte .20// for approximately_ GO 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 /> i. - L4S .4 /� S-3 -2DI <br /> Signature of Applicant-Title Date <br /> EVUB-SV_WKWASTER.PSIENCROACHMENT PERMIT APPI.ICATION.DOC (OV0111 <br />