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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date - d3 -12 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# <br /> Department of Public Works —�APN REF# <br /> CR# <br /> EXP. DATE 2 r <br /> Pacific Gas and Electric Co. VALID o , z DRIVEWAYS: <br /> P.O. Box 930 STREET P-t PON Q Y <br /> AREA ie 1_ po n 1 QUAD <br /> Stockton, CA 95201 TYPE —get-z- M&d,(- <br /> FORMS _S'.S 1 ,Q 2 S <br /> NOTES <br /> 9q2- iys� <br /> (Are;f Code-Telephone Number) <br /> 7Sketched plans may be submitted) <br /> ached sketch. Traffic Control Plan <br /> PM 309y/3S� Shall be as per <br /> Notif. �oG�� �6 current M.U.T.C.D. <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 A10971-1side of LJESY !Zt/�p�„/ <br /> of .-/��L�/ZLCK 12L 1?L!'D�/ approximately feet/n*e ERST <br /> by performing the following work(description of work): <br /> 1.Jv2K <br /> Lxe,4r✓�r�� �o�� ouE2 GftS rrl�q�nls 7Z> <br /> Tv �L vo c« Z--c/ 4 1,27' p-vv 1>44tIZ5:0 <br /> /�S P/�AL.T /IE'l�L/J C'�:/YJE.CIT s'ry FUL L DLJ. <br /> Work will commence on or about 9-/v -i2 <br /> for approximately 90 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 /> LEAS A C <br /> v- Signature of Applicant-Title �-��'!Z <br /> Date <br /> EAPUB SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />