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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date //- 7—/Z <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# �j, s,� REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP. DATE 3 �� <br /> Pacific Gas and Electric Co. VALID // /2 0 3/ /3 DRIVEWAYS: <br /> P.O. Box 930 STREET ,��r�q�6 � <br /> Stockton, CA 95201 AREA 5 ,,/ QUAD � <br /> TYPE �c� ALES Z <br /> FORMS kK� <br /> NOTES <br /> (Area Code-Telephone Number) <br /> r <br /> tch (Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> PM 3o9S7�S9 Shall be as per <br /> Notif. /'p�Z,���Sy current M.U.T.C.D. <br /> California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach o County Highway Right-of-Way on <br /> the SO07'H side of rI'!/�,2,��2 Gp,4 �a <br /> of /�Lc)�/ 91 ,�,eo,✓rgGE fll�. .STOG/CTp,� approximately 3335 3359 feet/n� 64-C <br /> yy� s /n�/ZF�2Go� R by performing the following work(description of work): <br /> Cc it oFF p� Sck'i�rc t /q, ] 807-1/ 17AI �jfZT KED. <br /> Work will commence on or about_ i/-2/�-/z <br /> for approximately 90 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 /> 64S A ;2_/z <br /> Signature of Applicant-Title <br /> Date <br /> E'PU&SV.WRIMA$TERPSIENCROACNMENTPERMRAPPLICATION.DOC (OMS) <br />