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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /-/,Z -/.3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID TO j 13 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. Box 930 AREA QUAD <br /> Stockton, CA 95201 TYPE I <br /> FORMS ss -Z <br /> NOTES <br /> ( �09) 9�.2-14198 <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 d9;10 yO185 current M.U.T.C.D. <br /> Notif. /peo,',6.2&gS-D 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 64S7' side of /./14j Y �. ,E RD approximately .So feet/ _SOur.A! <br /> of 1>7uA1A2o.12L1 i4tlE. A`TbC��aA! ,by performing the following work(description of work): <br /> l3a11_Z)eA/1.- .ZS 7D <br /> E X e-4LMrC /1DLE 0 Al Z <br /> /ALL ZJI-)121( iU A' LlD._l,C _rAl Ll t�T <br /> Work will commence on or about - y-03 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 /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />