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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3aOSa�� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 3115 J3 <br /> Pacific Gas and Electric Co. VALID 2 3 J2 T DRIVEWAYS: <br /> 3 !� 1S <br /> STREET iM1061D /910 . <br /> P.O. Box 930 AREA -5r4a�Taflls QUAD <br /> Stockton, CA 95201 TYPEFORMS ss AW, zf <br /> NOTES <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 30453193 current M.U.T.C.D. <br /> Notif. 106.28249ZL 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 SOL17'11 side of 4L/�1/L700Z AL/16 approximately /D6 feet/fade EAST <br /> of h'7/SS/D�! /,1yE srb(f 01 <br /> by performing the following work(description of work): <br /> 08L0 ELMLJODI� <br /> €X CALLA TE /IDLE 00152. !/-JS /YIA//J CUT OFF DLtz <br /> -W.57, A.1ELJ S /Jl�E. )qLL L "O2 TO 315 t�o.�1E 1"�c1 �/liJVLI r4tZ�i4t. <br /> Work will commence on or about 12- 3-12- for approximately 940 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 /> v —G145 5-/2 <br /> Signature of Applicant-Title Date <br /> EAPUB-SV.WKW9ASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (07/08) <br />