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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- �j34oS�2-� REF f <br /> Department of Public Works APN CR-# <br /> EXP.DATE 3 <br /> Pacific Gas and Electric Co. j VALID z « TO S �� DRIVEWAYS: <br /> STREETAZE o <br /> P.O. Box 930 i AREA 4� QUAD &2S ` <br /> TYPE fEc • <br /> StocICtOr1, CA 95ZO1 FORMS <br /> NOTES <br /> R64 Wo &1 AR <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 30Ci1;z 15 y1 current M.U.T.C.D. <br /> Notif. /06625975 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach or!bounty Highway Right-of-Way on <br /> the SDU7-1-1 side of !-'9ZELTvA1 IgLJZ approximately , a.&N feet/rAde W40' <br /> of f?ESn/0 /4LJE .STOeKTot! by performing the following work(description of work): <br /> 17V3 Z J. /44ZEL7-0AJ AV6, <br /> EX C-AU/aTL Ouz 2 6lgS /YJ/1Al AA !�i CuT OFrc .SE,e!/lCL�. <br /> nLL LJv2K Tv BE 1)olaE -r/cl bl2T /q,fZEfq. <br /> Work will commence on or about .2-//-/3 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 /> T 6AS t-1.D.E. <br /> Signature of Applicant-Title Date <br />