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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �Z 1J l �Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# ? SZ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Is 26 @ <br /> Pacific Gas and Electric Co, j VALID -�(- 6 TO --l5 DRIVEWAYS: <br /> � STREET <br /> P.O. Box 930 AREA iQUAD Or <br /> TYPE pip t10 C ` <br /> Stockton, CA 95201 <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 369 L!� �y ' ' current M.U.T.C.D. <br /> Notif. 10 61 (�23 i California supplement. i <br /> The undersigned hereby-applies for permission to excavate,construct and/or otherwise encroach on County Highw�a,yy Right-of-V�lay on <br /> the - side of 10 ' 13'9 e C�;e r2 (Z l) ,approximately 966- (9 Nile ! <br /> of - (4 W �J 2- c0 S /0C,&�o.v by performing the following work(description of work): <br /> ',r gel 13-e A6/-� f� t"e A�.'r ,���441 -1.1,1 <br /> lJ�Vl ))'-A,bit/ <br /> Work will commence on or about for approximately 1,5"6 days. <br /> I,the undersigned,certify that I am the owner of the respective properly,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 /> Signature of Applic t-Title Date <br /> FVUB.SV.WIMA*nUS"CROACNEWPEMUAPFUCATION.000 PIMS) <br />