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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID �,3 T ,3 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET z <br /> P.O. Box 930 AREA QUAD <br /> Stockton, CA 95201 TYPE --�* <br /> FORMS di/w 9 <br /> NOTES <br /> Zzoq) I yz - /V-FB <br /> V <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See atta heds ketch. Shall be as per <br /> PM 3current M. <br /> 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 LL16S7' side of QgFL 'tlo27E 4uE approximately lye)5 feetlf+le- A1vRT11 <br /> of si o7TS 144-1,6. 46,04 )'oal , by performing the following work(description of work): <br /> . <br /> V0 Z1!5 A1612725 .0441,15./�' <br /> t . <br /> uCLllJia TE //OLS' OcJe.IZ Ll4-g 1 Wi911d Iq lb e:2 T DFS <br /> /ALL &"Z< Tv �E L7o�✓� .� �s�T i4pL�i4. <br /> Work will commence on or about 3-.2S- /.Z 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 /> Signature of Applicant-Title Date <br /> EIPUB•SV.WKWASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />