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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5- 30 -12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE L <br /> VALID 0 Z /z DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET oris <br /> P.O. Box 930 AREA S /c / QUAD 4M <br /> TYPE -:%aZZ� <br /> Stockton, CA 95201 FORMS s5 ww, z4 <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per i <br /> PM current M.U.T.C.D. <br /> Notif. �p� ��oso 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 a <br /> NO/2rA1 side of XZ'00_S 4 5 approximately /S"0 feet/ € Lj Si <br /> of L/FA/Tu214 14016. STv�iCTanl by performing the following work(description of work): <br /> /f31,q Gam. SGD%S 19eyL. <br /> ,EX eAL1,9TL /IOGE 00,61L <br /> G/tS SZ1Zv/L16 <br /> Work will commence on or about for approximately 12o 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 /> 11�v 6A-S - A L E S 3 y -/2 <br /> Signature of Applicant-Title Date <br /> E:1PU&SV.WKIMASTER.PSIENCROACHMENTPERMITAPPUCATION.DOC (01108) <br />