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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date 3-1 S- 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. j VALID ,3 2 TO Z. DRIVEWAYS: <br /> ET AX <br /> P.O. Box 930 AREAS QUAD f� <br /> TYPE Ofd <br /> Stockton, CA 95201 FORMS <br /> NOTES <br /> avg 9y2 - /We <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 30 911 yoy current M.U.T.C.D. <br /> Notif. /0591.15/:� i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the E6S7- side of /3EY,0Z W approximately 154'20feet/nft SourH <br /> of 1L),4rERLDv 2fl Sry 6Kron! by performing the following work(description of work): <br /> 2L2.5 /3E-Xg/L LAY. -- AbasE Te i3E DE�vu�E�1. <br /> EXICA J.aTF //OLE o0F_IL In.411,1 AAA f1iTUFF SEfZuiG�, <br /> Work will commence on or about 3-28-!R for approximately 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 /> �d A046A� G/4S- ALS 3-!5--12- <br /> 0X <br /> 20 Signature of Applicant-Title Date <br /> E:TUB-SV.WRIMASTERPSTNCROACHMENTPFRMRAPPLICATION.DOC (07)09) <br />