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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date G-// /Z OFFICE USE ONLY <br /> To: San Joaquin County [PN <br /> 'Z'3ec"T 7- Cp REF# <br /> Department of Public Works <br /> CR# <br /> TEPacific Gas and Electric Co. 3 ITO � 15- DRIVEWAYS: <br /> P.O. Box 930 I <br /> AREA "3rdc e-1 J QUAD <br /> Stockton,, CA 95201 TYPE �o <br /> FORMS 5s)ttiw, R..z9 <br /> NOTES `— <br /> 2-o(;- <br /> (Area <br /> o(;-(Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. i Shall be as per <br /> PM 3093/- d -133 t current M.U.T.C.D. <br /> Notif. /Dv �5 Zv6 California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> Right-of- <br /> the SUUT/� side of /3 Lk _TrltE�r feet/r�ite wfsT <br /> of �'I3 '��jy�E`c� approximately 3/ <br /> �iD�irroc/ <br /> 112 y /3 by performing the following work(description of work): <br /> E. r%r s� _ �u,vey <br /> �xG.4[JArE /�vLE D[J�fL GAs m,,91AI Z%/ <br /> 19.clU cc.T DFi� SE�[/ioE, <br /> Work will commence on or about 9-13 -12- <br /> for approximately 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 /> -12 <br /> Signature of Applicant-Title Date <br /> E.iPUB-SV.WKWASTERPSIENCROACHMENT PERMIT APPLICATIONAOC (07108) <br />