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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3- Y- 13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# �✓�GL—�y REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE A111 <br /> VALID DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. Box 930 AREA pl QUAD j <br /> TYPEio. <br /> Stockton, CA 95201 lrIL <br /> FORMS ,,0 <br /> NOTES 6A <br /> rea 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 98DSvS current M.U.T.C.D. <br /> Notif. /o 71.0,gg3 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 SDuT!/ side of approximately 297 feedffi#e c.�EST <br /> Of �'E�SHi�yG 19 a �iyC�CTvAl ,by performing the following work(description of work): <br /> ZJ,QR( io Aef 0AId- ZAI <br /> M&::klT To F044PDL0. <br /> Work will commence on or about 3-2.S-/3 for approximately C/o 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 /> 06 I&Le 3 - 41-12 <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKWASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />