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f- <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3-2D - l2 OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 7-loo-<Z 1 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co, j VALID 0 y DRIVEWAYS: <br /> I STREET c vfE- <br /> P.O. Box 930 1 AREA sT3dr.14t711/ QUAD <br /> Stockton, CA 95201 TYPE ,046 <br /> FORMS <br /> NOTES <br /> I <br /> 2Oq 9y2- /y9Z3 <br /> Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ITraffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3 D9l l9-�2 current M.U.T.C.D. <br /> Notif. /o5.q 77/,Oa 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 A/0le774 side of approximately 563 feet/mk L JEST <br /> of /)EL 1)90A/2-1E /-lyE. S7"Ocelsy.cl ,by performing the following work(description of work): <br /> /1353 L.). SG4)77S i4tJE, <br /> 'Ex ifALZiaTC <br /> TILL GL)ORW 73 8E -a/ n127" /4i-e4s <br /> Work will commence on or about Y-/G- /2 for approximately. 9a 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 /> 3 -2o-12 <br /> Signature of Applicant-Title Date <br /> E'PU8-SV.WMMASTER.PSIENCROACHMENTPERMITAPPUCATION.DOC (01108) <br />