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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:: ' <br /> Date `l L S z/Z OFFICE USE ONLY <br /> To: San Joaquin County JOB ' 730.52-� " REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / 2 <br /> Pacific Gas and Electric Co. <br /> VALID TO To ; DRIVEWAYS: <br /> � STREET r #�! ' <br /> P.O. Box 930 AREA 'GTac ranf QUAD e_Q_ — <br /> Stockton, CA 95201 TYPE 1-"*LL-t4°`t <br /> FORMS 5: /ZAAO. P Z4 <br /> NOTES —' <br /> - <br /> i <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 3 of 00 yWy current M.U.T.C.D. <br /> Notif. �oS yvi7y 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 ..S side of L,l- .4Aapproximately 2-V? - feet/mile 9' <br /> of !,-0i4elwo- by performing the following work(description of work): <br /> Work will commence on or about Z for approximately ?1/2 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 /> 40— 414/4 //7-S /Z <br /> Signature of Appli t—.Title Date <br />