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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3- / - /2 OFFICE USE ONLY <br /> To: San Joaquin County JOB#• REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE I <br /> Pacific Gas and Electric Co, j VALID RD 12- TO g DRIVEWAYS: <br /> STREET L N(,ELAS Arc, <br /> P.O. Box 930 ; AREA n1&ekMt4 QUAD uas <br /> Stockton, CA 95201 TYPE '- <br /> .o� <br /> FORMS lip— <br /> NOTES <br /> 2oq9yz-l y9� <br /> (Ara Code-Telephone Number) <br /> FNPotif. <br /> ed plans may be submitted) <br /> Traffic Control Plan f j <br /> ached sketch. Shall be'as per <br /> 4/1977 current M.U.T.C.D. <br /> oS9;z;z/.S y California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the E tl S-r side of Lys • 4/✓GELS-S 3T. approximately -229 <br /> feet/m#@s�aurF/ <br /> of HR�ELTOnJ /�uE, SroCKTati/ by performing the following work(description of work): <br /> G3 S. LOS .AAJGjrL S ST. /f9USE To !3E ©Ev�oLlSi/E�. <br /> E-14CR[//77-,C- /SOLE S'L£'$!//z 7. <br /> /ALL LJa2K YJ BE DQA.�' .7.A/ D//Z <br /> Work will commence on or about Y-/G-20 2- for approximately 90 <br /> 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 /> � GAS /�.c7.E . 3-zi-12 <br /> ure of A <br /> Signatpplicant-Title Date <br /> E:IPUBSV.WKIMASTERpSENCROACHMEM PERMIT ppPLICATION.DCC (O1N8J <br /> ., r <br />