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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date iD-/ -/2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALID U- _ 0 2T-0 /_/ =ZU � DRIVEWAYS: <br /> P.O. Box 930 AREASTREmC QUADI S w <br /> Stockton, CA 95201 �� � <br /> TYPE <br /> FORMS SS Z <br /> NOTES <br /> (*ea Code-Telephone Number) <br /> 7See <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> ached sketch. Shall be as per <br /> o95283 9 current M.U.T.C.D. <br /> Notif. /oG 2 3o AS 7 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 EA-S7- side of Co eAML 1-101-1-DLJ 2A approximately, 186 feet/m#e <br /> of LARK-{ 2D I ;r f y by performing the following work(description of work): <br /> 21 voo ZZORR 4L l-10LLQZJ tZD. <br /> EXCA U4 TE e uEe2 Z; S <br /> /�LL LJa2K To 136 <br /> Work <br /> ZAI <br /> Work will commence on or about /D-IT -/.? 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 /> Z <br /> SignatuAplicant-Title Date <br /> E:IPU&SV.WKIMASTER.PSIENCROACHMEMPERMITAPPLICATION.DOC (01/00) <br />