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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10- 3-/Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID Ll_t-ZoIZ TO 1-/� 2 � DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET SCcU S Avj- <br /> P.O. Box 930 AREA QUADS <br /> Stockton, CA 95201 TYPE �o\,` 4-AX ' <br /> FORMS SS/c.��„1 . )22 <br /> NOTES <br /> (20e7) 9V2- /V10 <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 3019-6'.2L ,11 current M.U.T.C.D. <br /> Not if. /,0 22 L 3 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the NvR r// side of Sco T1s 4 cJE approximately /'/Y feet/a� ��--cr <br /> of , S7'ac-lCryxl by performing the following work(description of work): <br /> /f3G� L�, SGco7S 1-��JE. <br /> EXC/!iJ.4iE /�oLEyr��i2 lffS /Yl�l.�l /,AJ 2 euT arF Sc/2useE <br /> Work will commence on or about /U - 21- /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 /> v - GJaS A.L.L=. /O -5- /2 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKWWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />