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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#• 5-o2-4 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 4IM99,19. <br /> Pacific Gas and Electric Co. VALID �� �� 0 DRIVEWAYS: <br /> 3 ! aoi <br /> STREET OAJ ✓ . <br /> P.O. Box 930 AREA $ QUAD jF'S ' <br /> TYPE <br /> Stockton, CA 95201 <br /> FORMS O wT -a9 <br /> " NOTES <br /> 2 0 q 9y2 - Vq,3 <br /> ( ea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30BS 70/3current M.U.T.C.D. <br /> I <br /> Notif. /O5-S3/DDS 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 SOUrl-I side of .SEG7-10AI IgLIE . approximately 116' feet/ s;r <br /> of /-1Gy Y 49 SIVe-Kra A/ ,by performing the following work(description of work): <br /> 4 AC/a L-11q rK' /ADL.Zyy�5 tL M/:4-'(A1 i4 til D ifZw r-D. F <br /> /lDusE -#4r 36/0 _SSer/oA! /qc% XS TD <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 /> - <br /> 9A-5 ALA: I ( - 1 - 1 ( <br /> Signature of Applicant-Title Date <br /> E1PU&SV.WKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01/08) <br />