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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE-PRINT. <br /> Date 0 ) f OFFICE USE ONLY <br /> To: San Joaquin County JOB# R��'6!EF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3- 1- -OLS ` <br /> VALID TO 3-,tDRIVEWAYS: <br /> Pacific Gas and Electric Co. STREETS F-.-% W, Fr�vl,k,-- o <br /> P.O. Box 930 AREA I ,nike('r QUAD 5 <br /> Stockton, CA 95201 TYPE R eA61-�v2 <br /> FORMS uOL� , 122 <br /> NOTES <br /> L7dN ►- <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 3a ` 43 5-4177 current M.U.T.C.D. <br /> Notif. �( California supplement. <br /> �_3 7,/, 76- e <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of approximately feedmile <br /> of I by performing the fopowing work(description of work): <br /> See AffaC e10 Qks etev,�'a. v /�+Qrk�d <br /> a.11' <br /> c cc /� !/ e_C V'/�G 1" <br /> Cit / A lits d✓e Wt L°YL 9 <br /> �a lticx l b 2 -f'►'o f /2 -e Q <br /> Work will commence on or about c-li; f for approximately z O 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 q'pplicant-Title Date <br /> E1PUB-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br />