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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -5-3D-12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 173005-1;.-(p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE !L / /Z <br /> Pacific Gas and Electric Co. VALID L 0 Z L _ DRIVEWAYS: <br /> STREETj�_L-1_'AlveM <br /> P.O. BOX 930 AREA 5-PCk 64 QUAD WS <br /> TYPE -I,c- O <br /> Stockton, CA 95201 FORMS ss .-29 <br /> F NOTES <br /> (20q) y2 - /ysg <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 3042-7Y/1D current M.U.T.C.D. <br /> Notif. IoLo 6,9357 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 &JL. 'LST side of />EL. A/ORrE /IL/." approximately 8 feet/wA& AVD/Z)-14 <br /> 77:9 of S GD JA UE. STQQ4'7-,Q 1 ,by performing the following work(description of work): <br /> 6tL A/v2TL /1UE• - <br /> L y,,-1q LjA 7-E Noc.E aUE2 z9AS /77i9/n1 1.A1 /,r2T A -A /-f.JL) G'r�T DFF <br /> SE2u/GE. <br /> Work will commence on or about -/b-I2 for approximately /20 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 /> 6AS Age <br /> (7Signature of Applicant-Title Date <br /> E:1PUO-SV.WKWIASTEP PSIENCROACHMENT PERMIT APPLICATION.DOC (07100) <br />