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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT:' <br /> Date /2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# `7.3D1JSZ.-(o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3 ►S !3 <br /> Pacific Gas and Electric Co. VALID W3 i o 3 , li DRIVEWAYS: <br /> STREET r*-C A109M AV-6. <br /> P.O. Box 930 AREA -- �„! QUAD A16 <br /> Stockton, CA 95201 TYPE -- ,�,b� <br /> FORMS lyw, ,2-29 <br /> NOTES <br /> ir�ag 9y2 -eyvt3 <br /> (Area Code-Telephone Number) <br /> 7Sketched plans may be submitted) Traffic Control Plan <br /> ached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. eb&32/738 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 LcJE ST side of QEL * A/o/LTE /•fvE approximately feet/m+le- n/vR7'11 <br /> of sCo7TS /�vE. STo�tCT'on! by performing the following work(description of work): <br /> d EL h/UlLTE /�c/F. <br /> Ue C'C1?L .q TE /SOLE DvE2 G.4� 1W,41..( IVAIL Gt 7- <br /> ALL LoDZK Tv BE t7o/JE ,•mit/ '61'e7- <br /> Work <br /> s.eTWork will commence on or about 12-3-/2 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 /> —J� <br /> Signature of Applicant-Title Date <br /> E:IPO&SV.WKWIASTER.PSIENCROACHMENT PERMIT APPLICATION.DDC (01/09) <br />