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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ID- ID OFFICE USE ONLY <br /> To: San Joaquin County JOB#- ',.� 01-(� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ''I I <br /> VALID !o �� TO 4111X DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. Box 930 AREA /p� QUAD <br /> Stockton, CA 95201 TYFORMS z✓ -/E V �� <br /> " NOTES <br /> (205) 932 - 65`ss <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> Traffic Control Plan j <br /> See attached sketch. ; ; Shall be as per <br /> PM 1q/y?S1D9 current M.U.T.C.D. <br /> Notif. 105Z"1`►Y qD j California supplement. i <br /> The undersigned hereby-applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the W&ST side of LA/, approximately //0' feetla%b A/01?-7W <br /> Of ElLr-fT 1n 1 LE Jw LO a r - by performing the following work(description of work): <br /> I/JST/�LL 2Y " GcfL[JG2T PIPE /RAIL) n1?1UEL )AY TU /IC-414E S <br /> AIL=L.J /'.41?KIA16 11055-3. <br /> Work will commence on or about 3-26- 2012 for approximately 40 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 /> /D-/o-P� <br /> Signature of Applicant-Title Date <br /> E1PU&SV.WKIMASTERPSIENCROACI*AENT PU MR APPLICATION.DOC (01108 <br />