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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /z-,�- /� OFFICE USE ONLY <br /> To: San Joaquin County F# �D --(�; REF# <br /> Department of Public Works <br /> CR# <br /> EXP.DATE ( ` Z <br /> Pacific Gas and Electric Co. j ALID t2 12 it TO ► �2 DRIVEWAYS: <br /> P.O. Box 930 I STREET rt i ar, * . <br /> AREA o QUAD <br /> Stockton, CA 95201 TYPE o <br /> FORMS „ tN •-25 <br /> NOTES - <br /> 1 �t 44 - I <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per 1 <br /> PM 3o 8834g4 <br /> current M.U.T.C.D. <br /> Notif. tossvqL{t� California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way <br /> the -Sn , ELL-side of��c t.:.l 161-1 Q qL) , approximately S'q g y on <br /> of <br /> PE W t N G r1y� feet/t� T-- <br /> S7'Q G t�Tb ,by performing the following work(description of work): <br /> X <br /> 1-40' . 0 A u ErYI Tb 1Z E'f�i� <br /> �--C GA <br /> • t r-1 161qt'..3 <br /> Work will commence on or about <br /> for approximately .z 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 d <br /> o the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> P <br /> Signature of Applicant-Title <br /> Date <br /> E:IPU&SV.WKIMASTER PSIENCROACHMENT PFRMTAPPLICATION.DOC (OV08) <br />