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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 10 13o 12_ OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID TO / DRIVEWAYS: <br /> P.�. Box 930 STREET t-T b 120, * <br /> AREA M& QUAD <br /> Stockton, CA 95201 TYPE ,pe -gQ� <br /> FORMS �`tlw. �_�S' 7-761 <br /> NOTES <br /> e � <br /> _Z aC, - 9 Y;2 - 1671 <br /> (Area Code-Telephone Number) <br /> Sk7Seeattached <br /> ed plans may be submitted) <br /> Traffic Control Plan <br /> sketch. Shall be as per <br /> PM 30q 5)Y1/1 current M.U.T.C.D. <br /> Notif. (O(p lR).T73 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 N side of E• PO c,Ti 9tz rZD approximately. 3 7,V1—by per <br /> of Ko zr2 3 7 y Z''11 i Ci C41 [Z /l feet/mile—� <br /> R �a v�,. forming the following work(description of work): <br /> B o o f Al-`/" /�1'PL ,0,�-4-hl Al• ,r ca v a <br /> (Z� Y•XY- c3 !1 la�(� iN Dif- 27 be Ce+ fo' � c <br /> F �� <br /> A 3 X1+4 I- �� �i S (� Y',r 32/ /,fid/ye <br /> Work will commence on or about 50 /Z for approximately <br /> 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 Applicant-Title <br /> Date <br /> EAPUB-SVINKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (07/08) <br />