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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date G �2� ( I I OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7.3z"5a— REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / <br /> VALIDo 2ti' -110 61 i/ DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET "a1s09 <br /> P.O. Box 930 AREA ,ogkrral QUAD AW <br /> TYPE GG46z,,5 <br /> Stockton, CA 95201 FORMS w , � <br /> NOTES <br /> i <br /> 9-,IL - lS9q <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> . Traffic Control Plan <br /> See attached sketch. Shall be as per m N <br /> :> <br /> PM 3o Z5"7'9 7'6q current M.U.T.C.D. Q <br /> Notif. 1o5`f q 'Z ebb California supplement. o o <br /> �-�m <br /> _ ov <br /> rO Z <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County HighwaRight-of- ay on <br /> the Lj e 5�' side of G our 5.A' X-t) G approximately /'F ee mile <br /> of S .F o e'(G o n s , by performing the following work(description of work): <br /> Work will commence on or about ol/zor for approximately -Te) 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 wo the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> 01 <br /> ,_6 <br /> Signature of Applicant- itle Date <br /> E'PUB.SV.WKIMASTERPSIENCROACHMENTPERMRAPPUCATION.DOC (01108r <br />