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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 41- 2 - 12- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 13oos-(Q REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE g I z- <br /> Pacific Gas and Electric Co. ' VALID 4 1�11Z TO 8 Iy DRIVEWAYS: <br /> STREET I,oWr-c Sa•t�omy.,�t�r� <br /> P.O. Box 930 AREA Loc(i QUAD <br /> Stockton, CA 95201 TYPE �I��oi in d; <br /> FORMS ww 9- <br /> NOTES <br /> 2D9- qyz - 1/1F8 <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 300f/S/016 current M.U.T.C.D. <br /> Notif. �p59�g���� 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 LVE-sr side of 404,449— S4C-P-ArveUrD Rh. approximately .2SyS" feet/r44e SviceT/,1 <br /> of H19RAl 5/ L.,tl, I L DAt - by performing the following work(description of work): <br /> Az 775- A/. LJWffc'_ S14--2 6670- 126. I-1011SE TO AC- DErhOE/si/L� . <br /> Lx 1_'001 725 D[J E. Z. G/-LS /YlAdit! 14AJL u7- <br /> oF,� S'L�1ZiXGE. <br /> TALL LJ012K TO 23E 8CK45 ft! n1127- A2E/q. <br /> Work will commence on or about 1-Y-16-12 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 /> 6A!S A. 1*,E, <br /> Signature of Applicant-Title Date <br /> E.IPU&SV.WKUASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />