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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date /-/3 /.Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73x05-2_ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z <br /> Pacific Gas and Electric. Co. VALID z /z o 1s' L DRIVEWAYS: <br /> STREET , <br /> P.O. BOX 930 AREA e A/QUAD <br /> TYPE 114e� ` <br /> Stockton, CA 95201 FORMS -V7 <br /> NOTES NOTES <br /> (�09) gyz-�y5s <br /> (Area 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 current M.U.T.C.D. <br /> Notif. 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 E11S7- side of S. LvS A.t/G«€S /q[JE approximately '1� feet/e�ile Sourly/ <br /> of /-1.9 zE'L rv.cy /nuc'. STOCKry ti/ by performing the following work(description of work): <br /> e4.17- o,:!.C� GA-S Tv 17f2 tom. 1,14ZCL7-,0.4l 14uE. <br /> EYCL.i4tJ/a Tom: //oL c G.gS f'1,41 -1 AA.40 GcsT a.�F SG1LL�/G� <br /> 19LL 4-),oIZK i� 3E 8,DA/z5 Ll/2T' 149E141 . <br /> Work will commence on or about G - FL13 - 2 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 nines and regulations of San Joaquin County and subject to inspection and approval.. <br /> 4921-11� GAS -Az--,ff <br /> 67 Signature of Applicant-Title Date <br /> E1PU8-SV.WNMkMRPSUCA0ACHMEM POW APPUCATIONAOC (01M <br />