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' P , <br /> r. <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: , <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County FAPN <br /> # <br /> Department of Public Works ! _ REF# <br /> JOB <br /> EXP.DATE <br /> Pacific Gas and Electric Co, j VALID ig?qA <br /> Z DRIVEWAYS: <br /> P.O. Box 930 I STREET <br /> AREA 3T—°�--�� QUAD r� <br /> Stockton, CA 95201 TYPE •- <br /> FORMS , <br /> NOTES <br /> I <br /> 2Dtea:Code-TelephonaNumbe—r—) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per r 1 <br /> PM 3v9//976 I <br /> Notif. current M.U.T.C.D. <br /> 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 .SUUT// side �U� <br /> ofapproximately, 278 feet/mfle <br /> /��2E <br /> -2E_SnID �9 , L . STDGKrOnd by performing the folldwing work(description of work): <br /> l X5'8 LJ. Tov /-JUC, hbTb L3E IJEn-�vuS��L�, <br /> EXCAc1AT"E //DL OUr-.12 GAS IY1/-�/itl IY / 1UD LoilG c6 /�tllCT �Y/U . T . <br /> Work will commence on or about y-/G-/2 <br /> 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 Hales and regulations of San Joaquin County and subject to inspection and approval., <br /> g ature�ofAppl&antTitle Date <br /> E1PU&SV.WRIMASTERpSIENCROACHMENTPmWAppUCATIONDOC (01108) - <br />