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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 41- 2 - 0— OFFICE USE ONLY <br /> To: San Joaquin County JOB# 'jREF# <br /> Department of Public Works APN CR# <br /> EXP.DATE s71 15. <br /> Pacific Gas and Electric Co. ! VALID /a TO 0()112. DRIVEWAYS: <br /> STREET La wcr S4e.�a►.npr��o I�f• <br /> P.O. Box 930 1 AREA Lodi QUAD N&j <br /> Stockton, CA 95201 TYPE 'S <br /> FORMS Ss�lvw� <br /> NOTES <br /> 209 - qyz - 1,1,3 <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 30515/C>.'-/ ! current M.U.T.C.D. <br /> Notif. �o59Y��t3� California supplement. j <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 [yEsT sideof L.0zjg9_ S4r_R_A 4e.Ajro approximately S27 feetl:nile A/oRrd <br /> of M c-YntE/'Z /zb. LD8 t by performing the following work(description of work): <br /> ,V, L QWZ52 /�c�4rvmF v7'o R L�. /IUUSE ro AC- <br /> Ey, <br /> E[_''x 4-4 y12 rE 0LJd7Z zm'&S 1W,411lL 14AJL Luz- <br /> 17LL L..JD2K 7'0 LLE 6CVt![: -Z:'/L/ x�r2i 1q-)2,6'1, <br /> Work will commence on or about 4'-/G-/I for approximately q0 days. <br /> I,the undersigned,certify that I am the ownE!r of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with tho rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> 0 Signature of Applicant-Title Date <br /> E:IPU&SV.WKIMASTER.PMENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />