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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date 10-2 -12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ft 7SC�(-7�REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l- /S-20 13 <br /> DRIVEWAYS: <br /> Pacific-Gas and Electric Co. j VALID !O-/S•2�i�ZTO 1-/J=2��3 <br /> STREET <br /> P.O. Box 930 i AREA S Z(--ow QUAD l rJ S <br /> TYPE - <br /> Stockton, CA 95201 FORMS <br /> " NOTES <br /> i <br /> (coq) 9yz -/y98 - <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> . I <br /> Traffic Control Plan <br /> See attached sketch. ; Shall be'as per 1 <br /> PM 305S2Y73 current M.U.T.C.D. <br /> Notif. /od 22 f 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 SDU7-1-1 side of A0,6 approximately .2 06 feetta& we-sT <br /> of FRE.SA/D , . .STOcKToAl ,by performing the following work(description of work): <br /> EX CA U 7-1 f- Qv,5 2 GAS M41A! AA-//> cuT oFr� SE2vsc� <br /> /9LL ZJQ2X To BE DOnIE sAl LlI27- /gILEA. <br /> Work will commence on or about /D -/S-/2 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 /> G^S R.D.6:-. /0- 9-12 <br /> Signature of Applicant-Title Date <br /> E:1PUB-SV.VWAASTERPSIENCROACHMENTPERMITAPPLICATION.00C (01108) <br />