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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3o�5a���p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE J3 <br /> It 10 <br /> VALID Tb &IlCrI13 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET �/ �. <br /> P.O. Box 930 AREA QUAD <br /> TYPE p <br /> Stockton, CA 95201 FORMS L rrn o <br /> NOTES <br /> - <br /> (A(ea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> Sea attached sketch. Shall be as per <br /> PM 3o4 77D7g current M.U.T.C.D. <br /> Notif. 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 L.JL.CT side of S. AZS7-lAi F—b- approximately G 2 S feet/ A1,09r)q <br /> Of DXW1-,4 JL , by performing the following work(description of work): <br /> /1-ID.21 S. Rb. <br /> 4JaRK To BG" L)DAJ,6 fit/ PAucsZ P,9ElZrn,4.c1,6AJr i4s�'H/�LT <br /> rI EAlr TD FDL L DGJ <br /> Work will commence on or about 3-Y-12 for approximately '70 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 /> 46 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKWASTER.PSIENCROACHMENTPERMIT APPUCATION.DOC (01/06) <br />