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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /-//- /L OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# _ <br /> Department of Public Works APN CR# <br /> EXP. DATE 15* I'L <br /> Pacific Gas and Electric Co. VALID s11311-L- 0 2 is- it, DRIVEWAYS: <br /> i STREET ''t aR1TeQsewl QD� <br /> P.O. Box 930 AREA QUAD hg <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> 20'7- <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 3ooi3oY3y current M.U.T.C.D. <br /> Notif. lv,&.go;z Y�Yo 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 LyfsT side of P,4r725-,P-SD,cs 12.6 approximately 46Ci! feet/rAe <br /> of HZO y 2 6, S 0-ex7VA1 by performing the following work(description of work): <br /> 19021 "SfP:�2Sv.v .2,&. - !-"DuvT`f TD <br /> '4411 >E <br /> Cur-DF.�' S�fZuicE <br /> Work will commence on or about B- /3 - l2 for approximately 12v 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:IPU&SV.WKWIASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (07/08) <br />