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1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date V2 �l/_Zc�i Z <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73DbSo2-(o REF# <br /> Department of Public Works APN C4�� <br /> EXP. DATE Pacific Gas and Electric Co. VALID p DRIVEWAYS: <br /> STREETP.O. Box 930 AREA <br /> StOCICtO TYPE V61 e, r(ocA+\any <br /> n, CA 95201 <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> rraffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 36 s482-3 current M.U.T.C.D. <br /> Notif. f0a,�XSCo3 California supplement. <br /> jK <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> � , <br /> the6k!L C2"' st�iA/ Al-Ziss <br /> approximately feetlmile <br /> of ++ by performing the following work(description of work): <br /> Work will commence on or about_-Ii-c� o�-y� _ 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 /> 12 <br /> Signature of Applic t-Title Date <br /> EAPUB SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/09) <br />