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i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date - l - /z OFFICE USE ONLY <br /> To: San Joaquin County JOB# f.3�5Z-�o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE IS ,. <br /> Pacific Gas and Electric Co. j VALID Sal 2 12 TO 2 DRIVEWAYS: <br /> STREETxT�aN RTS <br /> P.O. BOX 930 AREA QUAD <br /> TYPE <br /> Stockton, CA 95201 <br /> FORMS s� ,ti.,,� ,&Zs. <br /> NOTES <br /> i . <br /> f <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 /> PM 3DgDL293 current M.U.T.C.D. <br /> Notif. IDS`t33�F3.Z 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 SouTl-! side of .SiccTiyA! ALJE. approximately /1 feet/ntte t.,E.s7- <br /> of /-/Ly Y 49 by performing the following work(description of work): <br /> 3613 E. SEDT/y�ll /kUF_. - EXC.4u/�TE /�yLE ovEI2 6,+s 1Y74/A.1 2I! <br /> Ati, Q�rT vFF z..4S SE2vlce. 1' tm��t�JT A.4ucsz,ci�� �'v <br /> FoLLo[.,. <br /> Work will commence on or about 3-12- /2- for approximately 100) 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 /> 1/o <br /> Azez-�-, Z-,AS ASL <br /> -2- 21 -12 <br /> Signature of Applicant-Title Date <br /> ewus-sv.wean&srEPPSXENCRDACFNENTPERMFTAPPuanow.00c (0iroa) <br />