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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3'Z,!- /� OFFICE USE ONLY <br /> To: San Joaquin County JOB#' 73006'2,'G REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l <br /> Pacific Gas and Electric Co, j VALID rz TO [ DRIVEWAYS: <br /> STREET ffA2tVrbtJ <br /> P.O. Box 930 AREA �kZ rV QUAD t e)3 <br /> • <br /> Stockton, CA 95201 TYPE -amu tfFORMS <br /> NOTES T� <br /> 209 ry.2 - /V q9 <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 91/ 9�S current M.U.T.C.D. <br /> Notif. /059 77/35 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 SQUT1-1 side of /-//I ZE[.iDA/ /J/J,E . approximately /07 feet/mi#e >�<F <br /> of F/Z'C*Sn./o /lUF_ , . .STVGKfDAd ,by performing the following work(description of work): <br /> /72D LJ. AIAZ6010J AUc, Abu.Se Tb A,-- QZE- vt_lSHeL1, <br /> EXCALJA7"E //DL DUCfZ G/1S Mi-4/Al /W6 CuT DFF , <br /> I LL L.JVJZK Ty BE Llc%!G Lc6 8127- /g12F,4. <br /> Work will commence on or about IV-/G-/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 /> ys.�el.�c� - 6/1 A,L. zS <br /> O Signature of Applicant-Title Date <br /> F.APUBSV.WKWASTEP-PMNCROACHMENTPERMRAPPUCKnOILDOC (07108) <br />