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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date T OFFICE USE ONLY <br /> To: San Joaquin County [AN <br /> OB# ��� Z-� REF# <br /> Department of Public Works PCR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID ,Z o ` s DRIVEWAYS: <br /> STREET ,�iJ�yjA fir- « <br /> P.O. Box 930 AREA 5!7d- 00A QUAD _ <br /> Stockton,, CA 95201 TYPE <br /> FORMS L5' <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 3093 7933 current M.U.T.C.D. <br /> Notif. ep6'-?�4.?S f 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 SDUT/f side of c. iYlhri,U ,.!�T_ approximately /S <br /> of G feet/mile E/4�T <br /> 32 e.vE 14a,6 .s-ToCX7_0V by performing the following work(description of work): <br /> x'232 /r!/a�� ST <br /> EXL/,tcJ/�TC /7/O[.E G>tJEf2 Gi4S rn.¢�n! .t.n!- pi¢uEt.� <br /> C 17- OFF <br /> Work will commence on or about /3- /Z for approximatelyy <br /> 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 /> /Q�lE _/t-12 <br /> ,17) Signature of Applicant-Title Date <br /> E.IPUB-SV.WKIWSTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />