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t <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 2 7 //z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 3c'65Z- (O REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 <br /> Pacific Gas and ElectricCo. VALID z7 tz TO i Fz DRIVEWAYS: <br /> STREET 5 4 <br /> P.O. BOX 930 AREAQUADS <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> -7 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 11 Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3 n� 1$64 7 current M.U.T.C.D. <br /> Notif. ( D(v O 1 fa Z oy i 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 C side of __ .5�"o ,t(,� ,,¢yp approximately fo Y 7 7 ee mile-��— <br /> of_F. F✓,P_ wi 0 $�, ,_ ���oc,��oh ,by performing thefollowing work(description of work): <br /> EX e,Aa o !ie 6z) ,e/-//6 �C' r u f &Fr— !t)(i sf 3/y`514 SErrvlc,E <br /> a12 r= uP� s► c <br /> Work will commence on or about 51Z7 / Z for approximately 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 /> / � -7 /Z <br /> Signature of Applicant-Title Date <br /> EAPUB-SV.WKWASTEP PSIENCROACHMENT PERMIT APPLICATION,DOC (01108) <br />