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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:/ <br /> Date �( �a2.5 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# -135005&-6 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /464/2- <br /> Pacific Gas and Electric Co. VALID 5 3a �2 TO /Z i , DRIVEWAYS: <br /> STREET /9AX—,PJ, <br /> P.O. BOX 930 AREA QUAD NMI <br /> TYPE Lj—t->t., 5 <br /> Stockton, CA 95201 FORMS �,,,�., <br /> NOTES ` <br /> 2 a <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 30f73517- / current M.U.T.C.D. <br /> Notif. 5 �/bbd 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 S side of .T.4l► R D approximately /7 4/Qe-ee 'mile Li-) <br /> of N• I-I j-& I R Gy-nn — 4424 ,by performing the following work(description of work): <br /> G A 0 iN6r (3) B&J / iN Z-)1W w ve N <br /> 13e/z <br /> Work will commence on or about 2 r— //Z for approximately 156 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 the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 72- 4W�� 1V <br /> / /2 _:r-//,)-- <br /> Signature of Applicant Title Date <br /> EAPUB-SVNIKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01M) <br />