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i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date X0 c63 l Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# �w 2.5 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 1 <br /> Pacific Gas and Electric Co, j VALID t2= t-20/ T 2 2ral DRIVEWAYS: <br /> STREET4QL U <br /> P.O. Box 930 1 AREA r.- QUAD ' <br /> TYPE ( ' <br /> Stockton, CA 95201 FORMS ss <br /> " NOTES ` <br /> (2D q) 9Y2 - <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 3 v 9 S2 Sq 9 current M.U.T.C.D. <br /> Notif. /o 6.226319 California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SDUT/-1 side of 1-b9�ELTDAI IgU,6 approximately 3lo B feethmie w.OEsT <br /> Of 'C"sn/D /wclE , ' .SrQCK7QA1 by performing the following work(description of work): <br /> EX CA UA T`,C- NULE Ovl-FL 6AS M41A1 AAJI> e"7- oFf SE.eti/6,'C5 <br /> ALL GJD/ZX Tv BE nolaE -zv Ll12r /mats. <br /> Work will commence on or about /7-/9 -/2 for approximately 9v 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 GA.S R.D.z5. <br /> Signature of Applicant-Title Date <br /> E"PUB-SV.WKIMASTER-PSIENCROACHMENTPERMrr APPLICOON.DOC (01108) <br />