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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date y—/,� _12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1,319ja—G REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE S1,5 l3 <br /> Pacific Gas and Electric Co. VALID '� !o i3 TO I�' 13 DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA c�6,�„�� QUAD - VAS <br /> Stockton, CA 95201 TYPE1=oRMs 1,u _09 -7- cum <br /> - NOTES 16 u eul <br /> 2 D Ci) el,2 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> I <br /> See attached sketch. Shall be as per <br /> PM 3D940.29D current M.U.T.C.D. <br /> Notif. 1vd,91.vS'� 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 e14sr- side of approximately YL feet/R*- ^,/c1zz741 <br /> 4 <br /> Of rCiZ .yZis ST .5iO4VOAI ,by performing the following work(description of work): <br /> 2-201 sr, <br /> mac.lef"4 X14 72 Ht�L� ouL�.fL LA-5 /YJ/1AI .4AJ16 j! cl r DFF 645 ��iQU/CLCD <br /> lex TO BAE. <br /> 177617'' 70 FOLLOGJ, <br /> Work will commence on or about for approximately 9e,> 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 /> r <br /> Signature of Applicant-Title Date <br /> E.-TUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br />