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t <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- fg ,05g!-Cv REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. -j VALID / it TO DRIVEWAYS: <br /> STREET y <br /> P.O. Box 930 AREA QUAD ' <br /> TYPE <br /> Stockton, CA 95201 FORMS ,e- <br /> NOTES <br /> �D <br /> ( ea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) , <br /> Traffic Control Plan 1 <br /> See attached sketch. ; ; Shall be as per <br /> PM 303,3701 current M.U.T.C.D. <br /> Notif. /a5S3o4102 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 LJ E ST side of A uE approximately 7-0 6 feet/r S ou77-1 <br /> of C L/9yrDl\l Aycr .S'TUGKToti/ ,by performing the following work(description of work): <br /> X e-lq u1/4 TL= /-/yL.E ou,6'2 /-tS CuT <br /> AT 3 323 Mou12)c1E6 4u,—r-- . -rS 7-0 <br /> Work will commence on or about 11-.29-11 for approximately FO 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.WKIMASTEP-PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />