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bilk <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /- 3- /,Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# (SbSL C REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE `j/,S_ 2yl Z <br /> Pacific Gas and Electric Co. VALID /- s 2o)2JO `�_ _ DRIVEWAYS: <br /> STREET C(4If a <br /> P.O. BOX 930 AREA '1i p1 -QUAD --ALE — <br /> Stockton, CA 95201 TYPE C �.� <br /> FORMS SS4LA)1 J 29 --- <br /> NOTES <br /> i <br /> (Area Code-Telephone Number) <br /> 7See <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> ached sketch. Shall be as per08965-as current M.U.T.C.D. <br /> Notif. 1,05,9279/1-1 r 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 ,SDLJrN side of cNLQotCEE PsZ, <br /> approximately </Oz fleet/mile c_)c_sr <br /> of LJlL/YI A 2TH 26 . STOGKTOti/ ,by performing the following work(description of work): <br /> EXC/_4 Ll/-1 i /-IoLE aF GAS M��w! /,i�►ll1 �26PL,4c€ GAS . 5, RrJ/�E. <br /> ALL QnEK TD ZEE LlOnlE -Z.V b127- /41ZER . ND i%91JEmEAI7' Tv BE BRoK,5AI, <br /> Work will commence on or about. 2- /2- /Z. for approximately 9D 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 /> f37/�/. O/• u TAS ALE l 3'1.2 <br /> p` Signature of Applicant-Title Date <br /> E1POBd1CWK1NAMPPSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />