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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date (p-M- 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 vast- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ►2- �- �'- <br /> VALID '�-23-12 TO M- 1- 12- DRIVEWAYS: <br /> Pacific Gas and Electric Co. j STREET K€rr+GMA)4 <br /> AREA tbl QUAD Air-- R <br /> P.O. Box 930 TYPE -e�>=u- No>S (Pp vEr> Aa <br /> Stockton, CA 95201 FORMS ss w <br /> NOTES <br /> (209) 9yz - l y98 <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 /> current M.U.T.C.D. <br /> PM 3c393z.Ig8 <br /> Notif. orb California supplement. <br /> 106o E3� <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Alo27'1-1 side of LA.! —approximately /Goa feetfffi c&2 S <br /> of Locus�" ?��� Lo1J/ by performing the following work(description of work): <br /> 92>6 E KET7LE"/rl�AJ LA/,NoUSc c��is-rnuT/c��l <br /> �)C CA cJ/�7'F /�oC� oyc�� G.4S 2Al P-'fy��� AJZ c-'cA- AAA t c c.T <br /> OF <br /> Work will commence on or about 23-/Z 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 /> - <br /> A.. ate. 6ZI 111.7- <br /> &'7' Signature of Applicant-Title Dat <br /> E.NUB-SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DDC WIN) <br />