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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date/3 /1,-1- OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE IZ <br /> Pacific Gas and Electric Co. VALID L9 1L TO DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA i-A'etde.\ QUAD <br /> Stockton,, CA 95201 TYPE <br /> FORMS 55 W� e-Z-9 <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 30el' 3 5 R o 3 ! current M.U.T.C.D. <br /> Notif. p 610-7790 f California supplement. j <br /> The undersi ned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of /U• l7 A/ ,*A) /2p. approximately 277't< 3 oy- eeee mile S <br /> of G iNDrA by performing the following work(description of work): <br /> vA f Zj &P// /Vo/,o 4 - y- D s vc <br /> • 4-0 -rrC--rlU A) ri w--s 1, c P <br /> Work will commence on or about 7 / 12 for approximately 9y 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 /> 7' J r <br /> Signature of Applica46 Date <br /> 111PHB-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (011K <br />