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• h <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- Cop REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Z,f,, <br /> Pacific Gas and Electric; CO. -j VALID V-22- DRIVEWAYS: <br /> TO 2- �-Zat� <br /> STREET f!SFA <br /> P.O. Box 930 AREA UAD kAp S ' <br /> TYPE 1 <br /> Stockton, CA 95201 FORMS <br /> " NOTES <br /> I <br /> (coq) ?Y2 41(?,5 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. ; ; Shall be•as per 1 <br /> PM 30952590 current M.U.T.C.D. <br /> Notif. ®oG22L2L2 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 .SDUT/-/ side of 1-b?Z6L Tv v /-IUE - approximately 78 feedmife W,,-� sT <br /> of f/?'Sn/D 14U6 , • STDGK7-oa1 by performing the following work(description of work): <br /> EX CA UA 71 f- Dc.u� 64S /Y74141 /-f/Ut�!) euT" oFic Se,&11Cz5- <br /> PLL LJQfZX Tv BE Doi lE -Zl 1)IRr /q96/q- <br /> Work will commence on or about 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 /> ETUB-SV.WKIMRSTERPSIENCROACMENTPERMfr APPLJCATION.DOC (07/00) <br />