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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# " 30052--(o REF# <br /> Department of Public Works APN 10 CR# <br /> EXP.DATE / 1 Y <br /> Pacific Gas and Electric Co. ' VALID /!o !t TO Z DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA 5IDa'raV QUAD <br /> TYPE LC, WoVe <br /> Stockton, CA 95201 FORMS 2, <br /> NOTES <br /> 20q qq2 <br /> ( rea Code-Telephone Numk)er) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. ; ; Shall be as per <br /> PM 309137si current M.U.T.C.D. <br /> Notif. 1059y9000 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 SOL1771 side of 7Z:L,65G1Zeg014 tq[1E. approximately 12L feedrA413 WEST <br /> Of— LJ n%S r'=-1z Iq JE. Zr0.CK7-QA1 by performing the following work(description of work): <br /> .21113 72CL,dE'G)FAP14 14clE, <br /> EXeIgygTE /-IOLC z90eJZ. 6i4S MAJAJ /4,LQ iZE8L/-I6E GAS SE�11leE <br /> Work will commence on or about Y-16-!-z 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 /> 0. Ate. E. 3-,26 . 12 <br /> Signature of Applicant-Title Date <br /> E:1PU&SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATIORDOC (01106) <br />