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f <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: , <br /> Date 3-o - 1.2 OFFICE USE ONLY <br /> To: San Joaquin County JOB2-(p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE y <br /> Pacific Gas and Electrilc CO, j VALID 1(0 1-2- TO z DRIVEWAYS: <br /> I STREET 09 S)A ( • <br /> P.G. Box 930 1 AREA STI•Y..1tMM QUAD _ <br /> Stockton, CA 95201 TYPE d1„r,- *. <br /> FORMS <br /> " NOTES <br /> I <br /> �2 0 9� gy2 <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 3 0 q // 3ta;z c rrent M.U.T.C.D. <br /> Notif. <br /> I <br /> Ar Access / allpra� &7-/a///,�s <br /> rZ' �s coir � a�cGss <br /> I/l�Q aG'cems <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SSD 771 side of InL71ZA 1)4 Lit! approximately /D feet +eof CDL 2. C4ST <br /> W4 14 <br /> by performing the following work(description of work): <br /> OIZ/Z)4 LA-1, B5 L7 )LIS 6�T . <br /> Cx�R v,9 72f' /7511c' vuL2 11,141,U LGIT DFF SE�1J/CE. <br /> Lv02K TD 13L-- LV� Z!l 1A1 4L45L 14fZEA . <br /> Work will commence on or about 5' 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 /> (/y`�L,.r <br /> 1/4-S ITE 3-17-12 <br /> O Signature of Applicant-Title Date <br /> EIPUBSXWI(IMISTER.PMENCROACNMENTPERMfrgppIICATION.DOC (07108) <br />