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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1 - 1 -13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# -(10 REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE 4 SP3 <br /> Pacific Gas and Electric Co. VALID ail j T DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA 5r46WA/ QUAD <br /> TYPE LL <br /> Stockton, CA 95201 FORMS ww, 4L <br /> NOTES <br /> V. ,til A&AouG <br /> (2,0q) <br /> /zI2 -/9/ 6 <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 30g71'311 current M.U.T.C.D. <br /> Notif. /o1,,,63gg72 California supplement. <br /> The undersigned hereby applies for permission to excavate,construct'and/or otherwise encroach on Coupty Highway Right-of-Way on <br /> the L&JES7r side of .-VoIZTE /qygE: approximately Alz 0 19 feetlff41@- A11JXr11 <br /> of sco7?S 441,6. , .�Td�tCl'onl ,by performing the following work(description of work): <br /> /ALL. Ls DZ< Tv 2?06' t742nlC X.Al blRr ,41Ze 4. <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 /> 40 Signature of Applicant-Title Date <br /> E..IPUB•SV.WKIMASTERPSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />