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I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 113o05Z. • REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE flZ- <br /> VALID 2. 1Z 11 T t _- DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET Las e <br /> P.O. Box 930 <br /> AREA G . QUAD �S <br /> TYPE a�- <br /> Stockton, CA 95201 FORMS ► <br /> NOTES <br /> 109 4Y2 - I Y`jS <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> ' <br /> See attached sketch. Shall be as per <br /> PM 3088`-I 5-08 ' current M.U.T.C.D. <br /> Notif. t oSSI eZzz 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 EAST side of LDS A til GELES AyE approximately 18 2- feet/mRe O 2Tl4 <br /> of W AS I-{ t N)6-TO N I. ,by performing the following work(description of work): <br /> E)CC,4OA1-4S ' x 3' l-+4-c7Lam' ouE2 fir/-�-5 rn�T cr`3 T-Cp G�--�z- oFJC <br /> L < Tu 73 S��CJ!G 4. eqiV 4510 P--+LZE�cFNTA-l <br /> TO Fol-Z-OU.) <br /> l3& S. Lo S AtUG,C-1-4FS /AvE. <br /> Work will commence on or about I[- S-t for approximately i 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 /> ignature of Applicant-Title Date <br /> EV'UB•SV.WKIMASTER.PS\ENCROACHMENTPERMRAPPLICATION.DOC (01/08) <br />