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ro <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- !7_?do5; —CP REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ' t x <br /> Pacific Gas and Electric Co. j VALID / 2k // TO .3 / z. DRIVEWAYS: <br /> STREET - <br /> P.O. BOX 930 AREAQUAD $ ' <br /> Stockton, CA 95201 TYPE ' rn!j�jrr <br /> FORMS `5 4,-,uO <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 303B3M. current M.U.T.C.D. <br /> Notif. �pSSao/DD California supplement. <br /> i <br /> The undersigned hereby-applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the E19S r side of z9ll 'L L 14LAC approximately 1,990 , feet/mile .9DUr1.1 <br /> of L'L/!y 2 _gr <br /> 2n AUE. _gC CTA�t6 ,by performing the following work(description of work): <br /> z'Ur DFG 6/-t-S M 39011 0,66a 40,5 1--kxis'g5 -i5s rD <br /> !�E /�ElYIDL/Si,��tJ. <br /> AEJ(CA4Ji47L ' 1-1aLE DUE.2 SAS 1>7A11%1 / A1h CUT S6ftlle -_ <br /> Work will commence on or about 11-29 - 11 for approximately 90 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 /> EIPUB-SV.WKIMASTERPSIENCROACHMENTPERMITAPPUCATION.DOC (01108) <br />