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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date // - 2, 5 - 1,2 OFFICE USE ONLY <br /> To: San Joaquin County FAPN _� <br /> ' c <br /> Department of Public Worksy�x�w,�` �� REF# <br /> CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID � �,: F� . T0 '�. DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 <br /> AREA 66 ni �A QUAD t <br /> Stockton, CA 95201 TYPEr— -- <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> See attached sketch. Traffic Control Plan <br /> Shall be as per <br /> PM f3:5-- .. 3Dq,6 Y.353 current M.U.T.C.D. <br /> Notif. 1,,96_3 L12,, 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 BAST side of -, yL)y ,te rms approximately u�jv <br /> of L 7'/42,0!' /Z J�, m ,�7—tics by perfrming the following work(description of work): <br /> c X C.4 L/A 7_2E_ l_/DLE 401 h!SZ2 G�4S /YI � �4�LU T CDF� 31-1- STEEL I"X91A <br /> ALL LJO.e,E' eO dE 440-kld ZXZ ve27- <br /> LoC,a r®onl 1�ETi�OL : CASs FRv�./7 /AGE �2L1. �Oc�' <br /> 9AtIC1I 300' <br /> "AlOF <br /> Work will commence on or about /-P_/2 <br /> 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 /> S <br /> G7' Signature of Applicant-Title ° 'Z`� -12 <br /> Date <br /> EAPUB SV.WKIMASTER.PWNCROACHMENT PERMIT APPLICATION.DOC )01/08) <br />