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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -1-11- 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE !f <br /> VALID $ !3fi3. TO lZ IS DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET yLc Ay�c, <br /> P.O. Box 930 AREA -&me-k nW QUAD ES <br /> Stockton, CA 95201 TYPE <br /> FORMS <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 <br /> PM 3e)Uo 1135 current M.U.T.C.D. <br /> Notif. /060520/ 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 F-,4SI- side of ani vE /AuE approximately /b! feet/mk A/c R,-/ <br /> Of /14>RA1Z--2 4u,6. SFOC-<rOAC by performing the following work(description of work): <br /> /aoG S. dLl�E />♦tJE. - G0"Alrf Tv 110~~. <br /> 6 C.9y.4rC lIaLt-- Dvu�1Z GAS /YI.�rci 2"iLlye2Z" .4fZE✓4 /�.c1y <br /> ea7- OFF SERu166 <br /> Work will commence on or about 9-13-12- for approximately /2o 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 /> Signature of Applicant-Title Date <br /> E.'TUB-SV.WKMASTERPSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />