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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: , <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County FSTRREET <br /> 73tl©S�- <br /> Department of Public Works REF# <br /> CR# <br /> TE �5-�� <br /> Pacific Gas and Electric.Co, j i3 iz T /51 't DRIVEWAYS: <br /> P.O. Box 930 Isr ,eipa,y ,2p <br /> AREA iPd QUAQ <br /> Stockton, CA 95201 TYPE '0t-E Prez <br /> FORMS ss Z9 <br /> " NOTES <br /> Z"E) 19yZ- � sg� <br /> (Area Code-Telephone Number) <br /> [Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan ! <br /> See attached sketch. ' ' Shall be as per <br /> Pot 301 -73t53 i current.M.U.T.C.D. <br /> Notif. I p 4ty ��z <br /> California supplement. <br /> i <br /> Thee undersigned hereby-applies for permission to excavate,construct and/or otherwise encroach on County HighZeNile <br /> Right-of-Way on <br /> side of W. Z�* o A) p approximately <br /> of— Ti N N;�y n �4h k <br /> y A� y,X by performing the following work(description of work): <br /> " //-/-/O/c' t��V D i/�t �n /�4rea.dr'2 <br /> Work will commence on or about Z i a i Z <br /> for approximately .. <br /> 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 /> Signature of Applic t-Title <br /> Date <br /> EMUB.SV.WMWSYE(1PMENCROACFNENTPUMAPPLICATIDNDOC (DMO <br />