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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -/23- 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE JI Z /Y <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas and Electric Co, I G /z /Z <br /> STREET �j�j ,Q <br /> P.O. Box 930 I AREA QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS svw ,C/-LS <br /> NOTES <br /> �2oq '7yz-1y9.� <br /> rea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. X0613/Y,ZB I 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-EA- i side of 19LI-1A 11B2t4 L/�l approximately 3D0 feet/flrile SoteTI--/ <br /> of MDXAb A Lal /f'!oR/t7/I by performing the following work(description of work): <br /> 9V23 /-1LI-11117,?BRA LAl. <br /> EX C.A L-1 A i 21� O LACI? Ze lq S /Y?A/Al /-7.c/L -CuT AFF _S�12tJlC <br /> 1�10,eK 729 aE Z�DAIE ZA1 c7/27- /-7966 . <br /> Work will commence on or about B- 6- /2 for approximately /1-14 - /Z 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 /> ,��521�L' LEAS ��G 7-10-1-2 <br /> 0Signature of Applicant-Title Date <br /> EAPUB-SV.WK MASTED PSIENCROACHMENT PERMIT APPLICATION.DOC (OIAM <br />