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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3 y s 03 OFFICE USE ONLY <br /> To: San Joaquin County JOB# ``�3sz—(p REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID r� o j �� DRIVEWAYS: <br /> STREET b Ao9,P 1,,s <br /> P.O. BOX 930 AREA 0tk-ZatO QUAD L,L <br /> TYPE 1.1. - <br /> Stockton, CA 95201 FORMS ss ww � <br /> NOTES e i <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`931DS2 current M.U.T.C.D. <br /> Notif./D� California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SDurIl side ofyxAo�y i..)AY approximately 3`ydi feefti#e i�JES7' <br /> of MI.SsivAI .4L45. —,by performing the following work(description of work): <br /> 1952 dxie-,oQz z..-)AY <br /> GL)O/Zfc 7 2B,6' PE2�vert�F� .Z�c/ P��D /Ji2�A� a��"Rrn.¢�clE.c�T /-�sPi�RLT <br /> l�EPLAC�/�Cc/T Tv �oLL DLJ <br /> Work will commence on or about 3-25-/3 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 /> n . <br /> Z;AS /9.L,t. 2 -.S- i3 <br /> Signature of Applicant-Title Date <br /> E.IPUB•SV.WKWASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />