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t <br /> APPLICATION FOR ENCROACHMENT PERMIT ' <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73.) REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. j VALID �'? TO r ;3 DRIVEWAYS: <br /> I STREET t�R��-t a s� A;/E _ • <br /> P.O. Box 930 1 ARE �QU D w� S <br /> Stockton, CA 95201 � d, <br /> FORMS ,.' <br /> NOTES <br /> I <br /> 10 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan } j <br /> See attached sketch. ;; Shall be'as per 1 <br /> PM 9 y2 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 SOLJT/•/ side of AIA Z-ELTDAI approximately .2149 feet/ EAST <br /> of Lo-3 /?A/GELE.� ST. STOCKToAl ,by performing the following work(description of work): <br /> TDAI <br /> ex e�cJ�TE /SOLE ayE2 GAs 1ntq!A! / AJL CuT OF.� .SEtvlcE <br /> /-AL L 1K To i3,dE' C)anle .LAI 25/2T AlZ e-:,A. <br /> Work will commence on or about_ for approximately 20 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 /> Signature of Applicant-Title Date <br /> EIPUBSV.WMMAS-rER.PSIENCROACHMENTPERMrr APPLICATION.DOC (01108) <br />