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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1-2-11 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# ADD 2 (p REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE / <br /> Pacific Gas and Electric Co. VALID /� TO 2- DRIVEWAYS: <br /> STREET n/,Coie� <br /> P.O. Box 930 AREA QUAD Z <br /> Stockton, CA 95201 TYPE `` "° <br /> FORMS ��l✓�y, ,e.��i <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 30,5711D2_ current M.U.T.C.D. j <br /> Notif. 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 SSUL,/71-1 side of znu. 1Fo2L1 AuG approximately 9/U feet/wMe <br /> Of. [v. F/Zyn/T',14GL TZ n _.570G!-fTDAl. by performing the following work(description of work): <br /> EXCil[./1 77,L5 3 '>C-? !!'AS x'1,4/AJ /qAJZ) CUi OFiF Se5ZLlle . <br /> /`/UUS,E 4-7- 30 yS ,*7a 11"02L) 4a f. 1-S' 70 32�' L�EI�IJL/SN�21. <br /> Work will commence on or about 9- 216 -// for approximately 4o 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 /> E:NUB-SV.WRV.IASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />