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• j " 'I <br /> i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date /a - - l Z OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 4,:f REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ( /t . , el j <br /> Pacific Gas and Electric Co. <br /> VALID k�—�-2L5 TO (_1 21c21 '� DRIVEWAYS: <br /> STREET �tnv!�cv� \lei <br /> P.O. Box 930 I AREATYPEv(4-1- QUAD W 5 <br /> •� ' . <br /> Stockton, CA 95201 FORMS ssl ww, P7- <br /> " NOTES <br /> (.20-F) 9V2 - I 1/' 1-73 <br /> '(Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan f j <br /> See attached sketch. ; ; Shall be'as per <br /> PM 3o95.2518 current M.U.T.C.D. <br /> Notif.. /ol.22d.311 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 SDU7-/.1 side of /aUE approximately 3S1 feet/raiie WE.S.7- <br /> of F/tEsn/o /4[J,6 .5ToeK729V ,by performing the following work(description of work): <br /> /75.2 Lv. 1-1122EL710ti! AaE, <br /> EX CA U A 7TC MULE Dutr2 G/t <br /> /ALL 4J6214 Tv BE L)oj J,6 _! L,,Rr 1VZEtq. <br /> Work will commence on or about /o-Z Z- /Z 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 /> Signature of Applicant-Title Date <br /> EIPUBSKWKIMASMPPMNCROACHMENTPERMITAPPLICATION.DOC (01100 <br />