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PEG FIVED <br /> FRESNO <br /> OMD/DFD APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT- <br /> Date M AL-C B 02 � 'C�l OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / �L <br /> Pacific Gas and Electric Co. STREET STo r /� DRIVEWAYS: <br /> • * <br /> P.O. Box 930 AREA 4J&Adg�-� QUAD <br /> TYPE <br /> Stockton, CA 95201 FORMS <br /> r'NOTES �T <br /> i <br /> -15'99 <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 36 Y,117A 65 current M.U.T.C.D. <br /> Notif./, s)6;� California supplement. <br /> The undersigned hereby applies for permission to excava e,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the���� side of//��rldi'ir��= — approximately a Umile <br /> of " PoL v Th�lC–n�� � s �' by performing the following work( escription of work): <br /> s ,4V0A1 AQx; DE WK 5 15W, <br /> Work will commence on or about for approximately. I days. <br /> 1,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 /> Signatuife of Appli ant-Title Date <br /> E1R1&SV.YMMAS7ERPSEXCROAQiJFM PFRt97APPtJCA710`1000(OtfiB} <br />