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a 201 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <517-o/ /Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7300$4 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3-1-1-3 <br /> Pacific Gas and Electric Co. VALID TO DRIVEWAYS: <br /> STREET /q/A/EA <br /> P.O. Box 930 AREA S7k14 QUAD Nw ' <br /> Stockton, CA 95201 TYPE soa- 1104 ' <br /> FORMS <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 '3o9 Gill tO current M.U.T.C.D. <br /> Notif. (O b 15�Sp 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 S side of F,. „AA i iorf-ll A0`P approximately INX /S'/ mile L✓ <br /> of (n o( r A) (9-P64 A V�PS�o e*,4vy by performing the following work(description of work): <br /> (I) Y'x y— /3 // //D%P ;N ASph4l 4- <br /> Work will commence on or about 11112— for approximately. 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,4he rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 1/1? <br /> /Z <br /> scant- e Date <br /> JAPPLICATION.DOC (01108) <br />