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� 1 ; <br /> r. <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#' �3cx�5Z_l REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID (1_1_22 TO I-/- SIS DRIVEWAYS: <br /> Pacific Gas and Electric Co, i STREET <br /> P.O. Box 930 i AREA QUAD <br /> Stockton, CA 95201 TYPE kl'4 <br /> FORMS <br /> NOTES ' <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan t <br /> See attached sketch. ; ; Shall be'as per 1 <br /> PM current M.U.T.C.D. <br /> Notif. I p G 22G 3/S California supplement. <br /> r <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUT/-1 side of IYA;�E'L:7-DA! /{UE approximately /00 feetliab EAST <br /> Of-LO-3 /aNGELE-q Sf .STOGKTa c! ,by performing the following work(description of work): <br /> l�3Z GJ. /�A��LTc AI 19L/E. <br /> EXC/-f t/ArE /�v�E Gu,ER GAs InAIA! aA N "r aF.� SFR[1lCE <br /> ALL L )DftK TO I3 - I- G►A/E lit2CR_ <br /> Work will commence on or about /9 - 2 2-17, for approximately qo 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 /> n� <br /> Signature of Applicant-Title Date <br /> E1PUB-SV.WKIMASnPPSIENCROACHMENTPERMrr APPLICATION.DDC (01108) <br />