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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 06-/Z OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3 13 <br /> Pacific Gas and Electric Co. j VALID z (Z TO 3 tS a3 DRIVEWAYS: <br /> STREET Low Arte&L,ES 'A-A—. <br /> P.O. Box 930 ! AREA QUAD WS <br /> Stockton, CA 95201 TYPEFORMS /ww, �-29 <br /> NOTES —� <br /> a SNL <br /> (Ara Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan t 1 <br /> See attached sketch. ; ; Shall be-as per <br /> PM �v gS�3 ' current M.U.T.C.D. <br /> Notif. California supplement. <br /> i <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the Et4S7' side of LOS * /?A1GELES S7 approximately feet/mft A1v27// <br /> of SeoJTS .vvE , SroeKiDA/ ,by performing the following work(description of work): <br /> SSS S. LvS ./In/GCLcs ST. /fauSE Tv .3E ©EAnoLISI.16A, <br /> EXC/-1L14 7-k /-10LE 4/,16 cf"7- aFF <br /> ALL GJa2K 7J BE DDw,E Zn! cDi2T. /42E.q. <br /> Work will commence on or about t2 3 *z 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 /> — 6A S q -12- <br /> 7( <br /> Signature of Applicant-Title Date <br /> BPUB-SV.WMVSrER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/00) <br />