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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# "�3a'Sa _� REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID I2 to 12 0 -3 15, DRIVEWAYS: <br /> STREET I-AT)4 c'P 2a. <br /> P.O. Box 930 AREA N1Awoesc,#g QUAD $� <br /> Stockton, CA 95201 TYPE $E L(. RO <br /> FORMS <br /> NOTES <br /> e0l,av�) 9�.2 - o4/9S <br /> (AFea Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 30 9S 9 VYZ current M.U.T.C.D. <br /> Notif. Opp 3 2 d .7 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 SDu7'1,1 side of L/-IT/-IRD l9 /2,8 approximately 21D feet/rf4e t.yEST <br /> Of— 2D. l3J. A1745CA by performing the following work(description of work): <br /> /SUS/ S. f/CJ� �9 BU/L�]iit/G To <br /> G X�/>f cJ/>rTE /-IDLE' DUEIL G�4� lY1Rl�t! I��11� �uT UFF .�E�UI��, <br /> /-71-L GJvRK Ta ISK _L(.l APR77=4Ref 4. <br /> Work will commence on or about 12-AU -12 for approximately 4;v 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 Date <br /> EAPUS-WWHIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />