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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date - //-/2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1366!"2-6- REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE LX Ar 12-Pacific Gas and Electric Co. VALID �z TO 12 DRIVEWAYS: <br /> STREET _Zb1&dW -Cyr. <br /> P.O. Box 930 AREA 5?Vr_4 aA1 QUAD ni5 <br /> Stockton,, CA 95201 TYPE ° <br /> FORMS <br /> NOTES <br /> 205 - I VZ - /y4t3 <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 3o 53oq3S current M.U.T.C.D. <br /> Notif. /oG o X7266 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 Srx/T// side of GJ/LLDLJ .ST, approximately 3 v 4 feet/a le ST <br /> Of 0=14A4627' Si STvc-.<73 cI by performing the following work(description of work): <br /> .2 q -V E. L.J ILLULJ <br /> Work will commence on or about '/3-12 for approximately /20 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 /> 6A5 ALE <br /> Signature of Applicant-Title Date <br /> EAPU&SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01M) <br />