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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3- I -/,? OFFICE USE ONLY <br /> To: San Joaquin County JOB# VX 5'?- -Co REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 2 <br /> VALID TO 8 /L DRIVEWAYS: <br /> Pacific Gas and Electric Co. � STREET <br /> P.O. Box 930 AREA QUAD �5 <br /> TYPE <br /> Stockton, CA 95201 <br /> FORMS ss <br /> NOTES <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 -30q//'779 current M.U.T.C.D. <br /> Notif. /059 770SL i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the—A'-19-5 7side of Z�!ZAKit: ALIE approximately 1/02 feet/rAe Sourll <br /> of SEC-/oti 4L1z ST�lc i OA) ,by performing the following work(description of work): <br /> 1�-Iq S. LRIAKE /-?u'E. . HyusE To 13E t�EyY70CIsl�L�I� <br /> ElCCi4tJ/ITE /-10LC 0uE12 1"41U 4AjZ) �uT OFA SCJLl1lGE <br /> ZJQ1ZX ro BE I�oynlE zy MozS0 <br /> Work will commence on or about '-/-23-/2- for approximately 90 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 /> G.4S <br /> Signature of Applicant-Title Date <br /> EVU&SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />