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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 73do!57Z- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /3— <br /> Pacific Gas and Electric Co. j VALID Ia TO / Z DRIVEWAYS: <br /> � STREET <br /> P.O. BOX 930 AREA jo*nzwd QUAD /t/ZO <br /> TYPE Uew <br /> Stockton, CA 95201 FORMS <br /> NOTES T� <br /> �ac19� 9y2�l y9B <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 3oL3y?-03S current M.U.T.C.D. <br /> Notif. /o52,7333 K ' i <br /> f <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Riqht-of-Way on <br /> the EAST sideof I-ozjz.2 S11c1ZAM6AI7-0 RLi. /-IT tvc7DL)BRInGE 2D- 141uz�) <br /> ,EX7-Z I,i1 .9Oc17-1! t.Jwy a�LtOG�r ,by performing the following work(description of work): <br /> SA/.S7',4L L A/E1� G/3S MA11,/ I3y DP,,5X/ 0.9AJ4) SO/2F T/lis G.Jo21< <br /> 1s rD 12Z rnon OLErEL 19,elo)Z Tv .TlVE SiQtc1 <br /> .Trri�'lZvyE�EVTS. <br /> Work will commence on or about /n42e1-1 3 20/2 for approximately l00 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 Applicant-Title Date <br /> E1PU&SV.WKWASTERPSIENCROACHMENTPERMrr APPLICATION.DOC (07108) <br />