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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -5-25- /2 OFFICE USE ONLY <br /> To; San Joaquin County JOB# 134a5a-4 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 12 11 7- <br /> VALID TO t, DRIVEWAYS: <br /> Pacific Gas and Electric Co. j STREET o ryE AvF. ` <br /> P.O. Box 930 AREA S7be_14W QUAD CS ' <br /> TYPE "BER6U__ ` <br /> Stockton, CA 95201 FORMS s w 2.7 <br /> NOTES <br /> 2 D q - I qZ/yq8 <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> i <br /> i <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3DU -7-Hl7 i current M.U.T.C.D. <br /> Notif. 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 E417- side of 9. cv_/of AMC approximately 20Y feet/m4e Alazl-,V <br /> of F41PLMI MAI .2D. .SrpfA7_O.J ,by performing the following work(description of work): <br /> .s .Zi✓ !�A[/ELl 4 RGA <br /> EX1,/a[J/-ATE /fyLC �yEfL G.4S /YIf►ltl �fc'� LceT oFF 6.15 �1?yIGE. <br /> PE2m/f.UL�!T /�s Pi�/ICT REl'L,4LEiyl�n./r- Ta Fr�LLo[.>� <br /> Work will commence on or about —for approximately 120 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 /> zrA5 OL--iC, <br /> 47` Signature of Applicant-Title Date <br /> E:1PNB-SV.W](WASTER.PSENCROACHMENP PERMIT APPLICATION.DOC (01108) <br />