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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date / /v - /3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7,3�Sa-� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID to Ste' >3 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET v <br /> P.O. Box 930 AREA 5�rAt,:krQ QUAD A6 <br /> TYPE ?t51G Ae <br /> Stockton, CA 95201 FORMS rev <br /> NOTES <br /> G tel"' <br /> &MV5. <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 309143 t current M.U.T.C.D. <br /> Notif. /oLL 3qS 7 t 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 Lc.J6 Sr side of Q,'L itlo2TE llaE approximately /B3 feet/ff 4Ie- n1v eTN <br /> of sCo7lS 4a,6. , .STo4tCT-QA1 ,by performing the following work(description of work): <br /> tOj!5L A./027r2' -4aZ. <br /> /ALL G",e< TD r3E t'O/t14C .Xt/ <br /> Work will commence on or about 2- 11- 13 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 (01/08) <br />