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N <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE_ <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB#, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 4115113 . <br /> Pacific Gas and Electric Co. j VALID f5 i�- DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA V QUAD 1--5 ' <br /> Stockton, CA 95201 TYPE Da <br /> FORMS SS <br /> " NOTES <br /> i <br /> 2-vq - qy2 <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 30$$ 1202 current M.U.T.C.D. <br /> Notif. 1.5 y9 VZ3 r California supplement. I <br /> The undersigned hereby-applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 5 side of DAA) 4 A& ,approximately 7—-21 feettmile G <br /> Of G►al✓P r Nb L L}�p , _ -'e-O L 44-0 r. by performing the following work(description of work): <br /> r z 44--t - y 19.8!1 me,& .�►'r l"K <br /> Z O 2 r '775r7 PF Z O 14re G .ic i iU <br /> Work will commence on or about , fj 2l //Z for approximately i 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 /> Signature of Applic -Title Date <br /> E1PU&SV.WKUSMR.PS'ENCROACNMENTPB ITAPPUCA710N.DOC (0106) <br />