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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q/57 I Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3 30652.-Co REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1p It t� <br /> VALID '33o �Z 0 (Q 1� DRIVEWAYS: <br /> Pacific Gas and Electric Co. i STREET Av6""S <br /> AREA 6 aler6AI QUAD CG <br /> P.O. BOX 930 TYPE a�44 - <br /> Stockton, CA 95201 FORMS <br /> NOTES <br /> (2097) 9yz -iv�� <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3o9 itis current M.U.T.C.D. <br /> Notif. l o f 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 SOUT'14 side of 2NrrLk SUE approximately 6 fee* EASF <br /> of M/a?-C RET' /a�l E. STOCKT'olJ by performing the following work(description of work): <br /> RC('A 2E� GA S LEAK. <br /> EX CAV/IrEC 3`X q, I-#oLE ou�12 fZE<'itcRc�� <br /> L—e4l< 7-H(S GJ AS m o til e- Z�(d PSL-)1—M�v T PE,e/►�r4�J C,vT P/�cJci'NE�� <br /> R6PI-/46C7'0 6-1-17- 7T) 90c-e-vw- <br /> Work will commence on or about 3-3 ca -1Z for approximately G days. <br /> I,the undersigned, certify that I am the oviner 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 /> GAs A . <br /> Signature of Applicant-Title Date <br /> E.TUB-SV.WKWASTER.PSENCROACHMENT PERMIT APPLICATION.DOC (01100) <br />