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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date Xd- B - /2 OFFICE USE ONLY <br /> To: San Joaquin County JOB#- �W2-G REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric; CO. I VALID tb22-1r-,t?TO 2-1- '7v13 DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 ; AREA K�cr.� QUAD -0<,' <br /> Stockton, CA 95201 TYPEFORMS <br /> NOTES <br /> (jog) 9y2 - 98 <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 3U9SzS92 current M.U.T.C.D. <br /> Notif. /U 22 626 9 California supplement. <br /> i <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 40,6 approximately 2 feet/rAde wE.sT <br /> ofF2E'SND /��JE <br /> Sr Al ,by performing the following work(description of work): <br /> EX c,4L)AT-,C- ac.uLL,2 6As /Y41An1 IjAjj� L44 oFz� sE.erisc <br /> ALL 4JQ1ZX Tv f3E nonj,6 —t! bl2T /'7/2Ees. <br /> Work will commence on or about -ID -22 -/2 for approximately 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 Countyand subject to inspection and approval.. <br /> 6AS (R.D.i5. 10 -9-12 <br /> Signature of Applicant-Title Date <br /> E•PU93V.WKWASTERPSIENCROACNMEMPERMRAPPLICAnON.DOC 01MM _ <br />