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7 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. i VALID �2 3 1i T 3 �5 13 DRIVEWAYS: <br /> I STREET IaJE, <br /> P.O. Box 930 i AREA ltd QUAD WS <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> " NOTES <br /> -A 6,tw/ <br /> I <br /> (Arda Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan 1 <br /> See attached sketch. ; ' Shall be'as per <br /> PM 30159y'1! current M.U.T.C.D. <br /> Notif./,0632/73! California supplement. <br /> I <br />' r <br /> 7 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAST side of LO-S ' 4A/GELE_S Sr. approximately /22 feet/mile Sd%iT/>s <br /> of H17z'CL7-2f W /a/lE SroerGrOAJ ,by performing the following work(description of work): <br /> 6/1 S. LOS .AA/GCL SST. /1OUSE Tv 9.-- ©Ev�oL es��Ed <br /> EXCRL/1:2 TE I-IdLE 04IE2 Ajn,/6 <br /> /9LL Q026 YJ BE- iDQVL E .TA! D/97 ig2Ef-A, <br /> Work will commence on or about l2 3-/2 for approximately 9a 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 /> 6A S -06-/2 <br /> .71 Signature of Applicant-Title Date <br /> E1PUB-SV.VMMASTERPSIENCROACNMEW PERMrr APPLICATION.DOC (OMB) <br />