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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /0 ._3/ -1Z OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73065L-6, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 5 1 <br /> VALID TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. Box 930 AREA SroGkrpg QUAD US <br /> Stockton CA 95201 TYPE 5► � �� QbgCIEiYLEKT'}3E,�,1, tSIL- <br /> FORMS 1!!5a VOW Z t Z,6(A ;711'61-G'/ <br /> NOTES <br /> ( rea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3 D3,5'7U2 current M.U.T.C.D. <br /> Notif. 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 AlL)121-1� sideof /.-J4r4f-'2[-Dy 12L. approximately 3.S- feedmk- � -T <br /> of "aC " ST.ei 'r Si0cXTy/,C , by performing the following work(description of work): <br /> 7v <br /> Work will commence on or about Oct i2 /L 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 /> 41-!S A.v.zf OD -3e- sZ <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01/08) <br />