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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date L - 3D-12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73Q9jj�a-lP REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID fo 2 t2 DRIVEWAYS: <br /> Pacific Gas and Electric Co. I STREET .9 Ave. <br /> P.O. Box 930 AREA --CNCoGkTotJ QUAD FS <br /> TYPE �L oLE <br /> Stockton, CA 95201 FORMS www, 2 2 <br /> NOTES <br /> (,20q) qY2 - I <br /> c <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 301q2 11572 current M.U.T.C.D. <br /> Notif. /p1/o3gq2 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 ERST side of Z),2,4KZ5 /30E approximately /yo feedp4le SST!/ <br /> of fO4/2T// S'T _S`ToGKTO� by performing the following work(description of work): <br /> EXe�q L,41T� !/vGE ovE.�2 G/�� /YI/�/.�/ nl /�Sl�iyALT Xl.�/,c� GuT <br /> DFi,::' 76 Fv�Lo�v. <br /> Work will commence on or about 7-23-/2 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 /> Signature of Applicant-Title Date <br /> EAPUB WAKWASTER.PMENCROACHMENT PERMIT APPLICATION.DOC (07108) <br />