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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 6�P ?3oc552-*">REF# <br /> Department of Public Works APN . CR# <br /> EXP. DATE 11-/—2U/2— <br /> Pacific Gas and Electric CO. VALID -j-21-zdlu0 11- (-2012 DRIVEWAYS: <br /> STREET FreAP-V- kc <br /> P.O. Box 930 I AREA JZ I Po QUAD 55 <br /> Stockton,, CA of Ir <br /> CA 95201 FORMS L,.> 2 <br /> NOTES <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 3a q'jy/D'7 current M.U.T.C.D. <br /> Notif. �1D6D�� �yg California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 0 side of .5 ry X-b r I<Ic y fZ O�Z.'pay approximately 2-70 'V a mile )L-2 — <br /> of w po N a 0 !7 1,2 &N ,by performing the following work escription of work): <br /> EX CA d.4 Ae r/ t/'"x y' 13-P// /,/dle /-0 i N/0 64 'A t,D <br /> /V, 6+,4_�5 3 11 t S. `✓r-0 Ce,-cle /Z P. <br /> Work will commence on or about -7. 1,9 Z for approximately Fo 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 th the rules and regulations of San Joaquin County and subject to inspection and approval.. <br /> �� 12- <br /> Signature of Applicant-Title <br /> Date <br /> EVUB-SVNIKWASTERP%ENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />