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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# lo�-�o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID �1 o �� DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA QUAD <br /> . Stockton, CA 95201 TYPE D0FORMs ,. <br /> - NOTES l <br /> -fArea Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM 3D'730 933 current M.U.T.C.D. j <br /> I <br /> Notif. /06 ?�?�3277 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 SoarN side of TELZ6R,4P/-1 /��/�'. approximately Yo 7 feet/p+le LJEsT <br /> 1:1Eof E A06 , by performing the following work(description of work): <br /> 2,6S3 /..)&-L1?A1L? <br /> LLL/ 3 - y-/3 PG if <br /> �v2�C L.44S a" <br /> RE!'L.gc���.vr Td rv�ldc,.� <br /> Work will commence on or about 3-Z/-/.3 for approximately 5r4a 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 /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKIMASTER.PS%ENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />