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' I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1ZD,j2- OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73V DSI REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 3-/—1,3 <br /> Pacific Gas and Electric Co. VALID TO DRIVEWAYS: <br /> STREET 41ye,c o'g <br /> P.G. Box 930 AREA StKF/ QUAD Nr ( <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> 7Sketched plansmay be submitted) Traffic Control Plan <br /> ached sketch. Shall be as per <br /> PM 3v01 191-14 current M.U.T.C.D. <br /> Notif. 1()(cl5 ( 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 S side of E. /A i IlJ Z /�t�rP <br /> Of (r a ol�t�-+ 614 4-w At)& �Iapproximately 2 Z"j mile <br /> sT/o"le f o,✓ , by performing the following work(description of work): <br /> Work will commence on or about for approximately f 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 /> J256A <br /> 0' 6- 2. 45 <br /> Signa re of Applicant-Title Date <br /> E:IPUB-SV.WMMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> PS <br />