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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# & REF# <br /> Department of Public Works APN f CR# <br /> EXP. DATE if /Z- <br /> VALID I TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET sE4,4w."i <br /> P.O. Box 930 ' AREA QUAD <br /> TYPE Z _ gEw�1vL6S ' <br /> Stockton, CA 95201 FORMS 5s4Lw, ,,29 <br /> NOTES <br /> (2o,q 'F412-A113 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> i <br /> Traffic Control Plan <br /> See attached sketch. i ; Shall be as per <br /> PM 111106 9q,61 current M.U.T.C.D. <br /> Notif. 10599 fBol 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 SDVTN side of 1?DSL51=ALJapproximately a17 feethr e S.4Lr <br /> of 12a,6AJ,1 L1isi,4 STyeK-ron! ,by performing the following work(description of work): <br /> Ex L.4 t_1 A TES 2 y,x2 1 m3LES 0yE2 '!;is lw'41 cs .LcG '0'46"E ZD <br /> 17,ec- To 1;?e ///2 .IA-S LE,4K_S, <br /> :'�E2mgi✓E�/i /�i4�/1�JYlE.yT ,P.�f�.i4CEsy��..iV7' T?S .�vL.GytJ. <br /> Work will commence on or about -/3-!Z for approximately .2 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 /> EVU6SV.WMMASTER.PSIENCROACHMENT PERMIT APPLICATIONAOC (01108) <br />