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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 43-F-6-11 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3po7-to REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP. DATE j Il <br /> Pacific Gas and Electric Co. VALID o rs fr DRIVEWAYS: <br /> P.O. Box 930 STREET 1—�! �. e5 A�1 � / gyp. <br /> AREA Lolv/ _ QUAD A4V <br /> Stockton, CA 95201 TYPE 3EZc ops . azEs <br /> FORMS 55fj� Z9 <br /> NOTES <br /> 3L17- 5N I <br /> (Area Code-Telephone Number) <br /> ;P, <br /> etch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> 30cs 3 ro5 y current M.U.T.C.D. <br /> \ Notif. /n5 25278 j' California supplement. <br /> The undersi ned hereby applies for permission to excavate, onstruct and/or otherwise encroach on County Highway Right-of-Wayon <br /> the yl/EST-s�.de of N De CYTStagapproximately UarJ"4vS <br /> of U1J G(0 —�� f feet/MM So(7 7l1 <br /> $ 1 P Card i7s 7<jC7 0�' 4 by perfor ing the followigg v�ork(description of wprk): <br /> car^ >� C3 .� /3a (2J 76' D`% N)ngl <br /> n OL11 <br /> Work will commence on or about— $ 1,5. /1 <br /> for e�ornx(maranr <br /> rr.._._..........J t k 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 /> � �s�')rn <br /> gnatUre f Applicant- tle <br /> Date <br /> E:IPUB,SY.WKIMASTEP MENCROACHMENi PERMR APPLICATION.D (D7)08) <br />