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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE;PRINT: <br /> Date /J Z OFFICE USE ONLY <br /> To: San Joaquin County JOB-# - REF ' <br /> Department of Public Works APN CR# <br /> EXP.DATE / �3 <br /> Pacific Gas and Electric Co. VALID /Z O TO / /3 DRIVEWAYS: <br /> STREET � <br /> P.O. Box 930 AREA 5vb,Ar1zv✓QUAD AE5 <br /> TYPE T,eE <br /> Stockton, CA 95201 FORMS Aloil -Z4 <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,*/?_,Z3(o1 current M.U.T.C.D. <br /> Notif. I 0(o2-s1851 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighwkRight-of-Way on <br /> the d_ IS side of E yti4g"�s2 approximately /�' Xeewile W _ <br /> of 1,/4[_Krl 2 t_n 61 , 15� ) , by performing the following work(description of work): <br /> Ex cAVA-T1,- _(z) 5 '3t$' aaLl2k,65 hx/a 3S' gtt JJf7aL r a "u-Ir-6 2�- fr�_ <br /> «5 MA-iA2 <br /> Work will commence on or about 0//a for approximately days. <br /> 1,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 /> tt <br /> Signature of Applicant-Title Date <br /> E1PU&SV.YlKV2ASTERPSLENCROACIOAENTPERI.BTAPPLICATIOtLDW(07108) <br />