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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ID-11-1.2 OFFICE USE ONLY <br /> To: San Joaquin County- JOB# y3po5a_ REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 13 <br /> Pacific Gas and Electric Co. VALID TO Z 3 DRIVEWAYS: <br /> STREET )9yE. <br /> P.O. Box 930 AREA QUADS <br /> Stockton, CA 95201 TYPE o e <br /> FORMS .Z <br /> NOTES <br /> �Vz -A/'79 <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 3DgS-313/ current M.U.T.C.D. <br /> Notif. /p,6.2 30_3;z2 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 S&.,7-1-1 side of 0/fh1/-9 4a2 approximately 357- feet/ra 6/9sT <br /> of 4L"Z, , S%l---?C7OA! by performing the following work(description of work): <br /> E�CG/f4/i1ie eT/DLE OrJL:2 G.9S !Y/.4�.c/ �4i�v Gui lJr'F 5�2voc� <br /> G.JDI?X i U -ZC/ 17i�Ze /�s2E�4. <br /> Work will commence on or about OD - 22- /2. for approximately 9v 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 /> UQ 72�& ei - G /4S AI& LE. <br /> &//," Signature of Applicant-Title Date <br /> E:IPU&SV.WK%MASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01/08) <br />