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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date a - 25- /3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 - REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE !�� <br /> Pacific Gas and Electric Co. VALID t T I,�!� DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA S o QUAD S <br /> Stockton, CA 95201 TYPE b <br /> FORMS �,�, A— <br /> NOTES ' <br /> �o� 9412 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 30 97,3,23S 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 E14s7- side of 0' 1-)ZLL. /Iu,� approximately 4".' 70 feet/#lp sv44r11 <br /> of .rvy /-7yE Sf0cXT'0A1 , by performing the following work(description of work): <br /> 3313 d' DELL /�cJE, <br /> ExcA,,11-1 rE AID LZ acJt�2 ��45 m.��,c1 �l.cl�l Cui aFG' .�aL� G.¢s .SE2cJrcc'. <br /> I4LL ZJDICIC 7v ZA 7 A i 10 T" A Fz,�54 <br /> Work will commence on or about y-/S-12 for approximately ?v 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 /> Aky'z k �/a S .r�.�. .?- 2 S- 13 <br /> Signature of Applicant-Title Date <br /> E:1PU8-SV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />