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• p . <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3-21- 1 z OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 7jZW6Z-&,- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 03h <br /> Pacific Gas and Electric Co. j VALID Iz TO DRIVEWAYS: <br /> STREET 44 g2iLZtt61 AIS <br /> P.O. Box 930 ; AREA 150e,00QUAD 1 <br /> Stockton, CA 95201 TYPE — E OLAC <br /> FORMS 5►5 G✓tN 1p+z.�j' <br /> " NOTES <br /> i <br /> zD9 9y� <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 30 911,7?6 current M.U.T.C.D. <br /> Notif. 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 SD lriz' side of AIA ZEL.TDA/ /9rJE . approximately 22.1/. feeder EAST <br /> of L0_3 19A1GE'LE.S ST - S70GK7DA1 by performing the following work(description of work): <br /> I�loQ Ls 1. 1-14ZEL72)A1 AL.,E, <br /> EX CA L//!TE /-1ULE 6L/E2 GAS Int4tAl 14AlD GUT OF.� SE1eLlCE <br /> ALL 1c),Q/2K To ne9lve _rill Z112T /3lZL✓,4_ <br /> Work will commence on or about 171-1,6 - 20./I for approximately 4o 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 /> 6A A.Q.E. 3-21- 12 <br /> Signature of Applicant-Title Date <br /> E:1PU&SV.WKUkMR.PMENCROACNMENTPERMrf APPLICA7nON.DOC (07108) <br />