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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 11- 20 - 12 r�2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# `,s�lJ '�o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ! <br /> VALID TO / DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. BOX 930 AREA QUA <br /> TYPE d '/N t <br /> Stockton, CA 95201 FORMS <br /> NOTES <br /> (�o� ) <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 3 o 5.59303 current M.U.T.C.D. <br /> Notif. It)blyoG?9 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 EASY side of GJ RZ>- approximately 1300 feet/i;l rt/yRT!/ <br /> of Ll?TffRDP 2D. IN11iJT."�44 by performing the following work(description of work): <br /> 99 <br /> EX G.4IJA TE //OLl� ©L)Z& / int/ /Q.Jv CUTOF Sc.e�/seL. <br /> 19LL L,)o,2K TU BE 60AJLr i-)127- i42E4. <br /> Work will commence on or about 1;2-/2 for approximately 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 /> 0 -12 <br /> A . �-6! 9/'249 <br /> Signature of Applicant-Title Date <br /> E:NUB-SV.WKIMASTEPPSIENCROACHMENTPERMITAPPUCATION.DDC (07108) <br />