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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date .5-23 -12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# `��fJ6 Sa-�`p REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. ' VALID 5-12-r 12- TO (nity�� DRIVEWAYS: <br /> STREET -1..m M A j11A A . <br /> P.O. Box 930 AREA —_ft"dckTGAf QUAD <br /> TYPE r-1 o e.f <br /> Stockton, CA 95201 FORMS12.2-q <br /> NOTES <br /> C-'2,9q) 91. 2- <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 3v921�07616 current M.U.T.C.D. <br /> Notif. 1o4California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SDc.IT/� side of X Vn"/*Al /7a approximately S feet/R:& !.-SEs r <br /> of i'ffE &/14sr' Pied o Liti/&- STo cltsoA! ,by performing the following work(description of work): <br /> cyF rnARGfI/2cT �tlE' <br /> S x ACA L14 r�Z y 'x V ' /YacfE I._4 P.¢UEs�rE.c�r- ro <br /> Work will commence on or about S-21- e 2 for approximately S-21- 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 /> o.4. --')--z 3 -/I <br /> Signature of Applicant-Title Date <br /> E:NUB-SV.WNIMASTER.PSIENCROACHMENT PERMIT APPIJCATION.DOC (01108) <br />