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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE-PRINT.- <br /> Date <br /> RINT:Date t3'Oy-9.? OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730SZ -S REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /Z l y- /Z, <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET CAIAW sTef,67- <br /> AREA LOI�I�`FoRO QUAD gF <br /> P.O. Box 930 TYPE 8E6L fJoL� <br /> Stockton, CA 95201 FORMS 5-S -729 <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 30 9 q 3030 current M.U.T.C.D. <br /> Notif. <br /> 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 a-DUTd side of C/-1UR6!! 'Sr approximately SD feet/rade L06--Sr <br /> of Cv Tran/ Z—/- LyGKt.FO,,P—0 by performing the following work(description of work): <br /> S!13S"S CoTTon/ <br /> €x C,.q rJA TE 1-/9t,�5' our 1Z 4'v4s <br /> /-1LL GJv 2 K Tb 2 T /1,4 <br /> Work will commence on or about 9—/V /,2 —for approximately 9d 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 /> S A D.c_. ZF-141- 12 <br /> Al Applicant-Title Date <br /> it!g�n`atureof <br /> E.TUB-SV.WKW4ASTERPSIENCROACHMENI PERMIT APPLICATION.DOC (01108) <br />