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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 73o66 REF REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE �I <br /> Pacific Gas and Electric Co. j VALID 3 TO h l DRIVEWAYS: <br /> 2 <br /> STREET Aftir.&AG,p ;g• <br /> P.O. Box 930 AREA 50iC7tW QUAD G!5 <br /> Stockton, CA 95201 TYPE 0""A10" • <br /> FORMS SSJw.v. ,�29 <br /> NOTES —T <br /> (20`l) qq.2 /y9S <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 3o4o48yy current M.U.T.C.D. <br /> Notif. /05.95�9g California supplement. i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the LJEST side of mDc/2F,/EL 6 AclE - approximately 757 feet/r*e -60arN <br /> of CLA-I D�l AU e5, .S70c1,001,1 by performing the following work(description of work): <br /> EX GigU11rE /-/ULE Oz. GAS zn1111A1 AA-1A --c,r oF"F GAS 5�2vt�. <br /> /-!LL !moo l2K 1S 72-) Re" —r4/ 1)//27" <br /> Work will commence on or about 3-2 6- /2 for approximately 4o 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 /> EIPUB-SV.WNWRSTERPSIENCROACMENTPERMRAPPLICATION.DOC (01108) <br />