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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date c3-/U -/2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3Q�o7-�p REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE z la <br /> Pacific Gas and Electric Co. VALID /y/a T !x i h- DRIVEWAYS: <br /> ET <br /> P.O. Box 930 AREA <br /> r4Nnr-e--4 QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS SS LylnJ) <br /> NOTES <br /> (2.09) <br /> (Area Cole"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 y.2 Y30 current M.U.T.C.D. <br /> Notif. .525o 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 EAST side of I-ILo l 19 FlZJ.yT�GE approximately 210 feet/mde SvcrTi� <br /> Of— L/T Tt/l�DA R� /�'IA�/T�GA by performing the following work(description of work): <br /> 9Ci - /`/D�lsE Tv <br /> ZAZ <br /> CuT oFF SEr2�/iCE', <br /> Work will commence on or about 9-! -!2 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 /> 00 - 6AS A D E 3-10- 12 <br /> p Signature of Applicant-Title Date <br /> E:IPUB.SV.WKIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (01108( <br />