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I. <br /> • M' <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3 <br /> VALID tz-t-7211_TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. I STREET N4G�} c�l� V ' <br /> P.O. Box 930 i AREA QUAD lam`S <br /> TYPE <br /> Stockton, CA 95201 FORMS 1)s <br /> NOTES y f <br /> ' I , <br /> (coq) 9112 V-73 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan t 1 <br /> See attached sketch. ; Shall be"as per <br /> PM current M.U.T.C.D. <br /> /0,/ 22�2g5 <br /> Notif. �pC California supplement. <br /> The undersigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highway Right-of-Way on <br /> the SLUT/-/ side of Hl-?�ELTDAJ /-?UE _approximately /99 feet/mP- W6 <br /> of by performing the following work(description of work): <br /> 2t3 <br /> EX CAUATL HOLE avgAr 6lgS /Y41A1 /xiQ GuT of c SE2vlc� <br /> 14LL LJU2K To BE Dof.lE -Vcl Z)1127- 17-96A. <br /> Work will commence on or about -fl-/1-12- 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 /> t GAS (4.U.i5% B - z <br /> Signature of Applidant-Title Date <br /> EAPUBSV.WKIMASIER.PSIENCROACHMENTPERWAPPLICATION.DOC {0110M <br />