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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 13 ao 52-^Co REF# _ <br /> Department of Public Works APN CR# <br /> EXP.DATE 17.115-111, <br /> VALID tL TO tit DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET ya�6iL Sr; <br /> P.O. Box 930 AREA 41vaerD&I QUAD <br /> TYPE <br /> Stockton, CA 95201 <br /> FORMS <br /> r NOTES <br /> 2v4 - '91Y2- 4/- 9g <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 30303 current M.U.T.C.D. <br /> Notif. ✓060?SZoS I 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 EAST side of U/1ZGI1- Sr approximately 4/01-/ feet/41e SvuTN <br /> Of— L E*0AJ, 12,S r.AJi 12b Sioe_01el-OV by performing the following work(description of work): <br /> L/52 lv U/2 6/G S T_ - LOGl.�/TY Tv Ll E�o L/SFf /,ic�rt�lE <br /> X�GJATE NULL C21J /Z GAS �"Yl�i.t! .rig! P,l6& l i¢12Ei4 <br /> Au& cL.r <br /> Work will commence on or about 8-13-12 for approximately /2 d 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 /> Q Signature of Applicant-Title Date <br /> E.1PU&SVOKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC M1108) <br />