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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 8 j- 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID �!' I7 L TO / i 13 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET .ah X,e. <br /> P.O. Box 930 AREA QUAD �5 <br /> Stockton, CA 95201 TYPE Rea <br /> FORMS gV.VW _ <br /> NOTES <br /> (20 9) 9 y2- I X195 <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 .30%q2232 current M.U.T.C.D. <br /> Notif. /DG/5,32S3 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 side of L/LL!/1AJ /?Oz—' approximately 1&.'v feet/roile -9Z)u771 <br /> Of IgA/TL-1eD.S sTDGKI-,OAJ by performing the following work(description of work): <br /> G2`-1 L/LL/An/ IILJ - <br /> CuT UFF -4 L C GAS SEfZ[JIGE64 l.,)0R,'e To 2E c�yn1E <br /> 1AJ Z 2T /I/2.cL'fJ. <br /> Work will commence on or about 9 1?-12 for approximately 9v 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 /> 0 Signature of Applicant-Title Date <br /> EAPUB WWKWASTERPSIENCROACTIMENT PERMIT APPUCATION.DOC (01108) <br />