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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 52>5,t-— jp REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 811113 <br /> Pacific Gas and Electric Co. VALID 3 DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA �,J QUAD <br /> TYPE L1.14 tAk <br /> Stockton, CA 95201 • <br /> FORMS Z Q �� <br /> NOTES <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 3D99D/93 current M.U.T.C.D. j <br /> Notif. 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 Syu7-/1 side of Si-AID I"4 AVE approximately 3 7S' feetJr I.yESr <br /> of ARK .S Z- - <br /> I-.5rOgn<770A I ,by performing the following work(description of work): <br /> 3OS4 !i. S'O'C/o <br /> �4&e,4 225 459I f11PZ -.4 <br /> l��R�iO�/�.c�r ASPi�.9LT ��PL•¢�E/'t�1 /T Tb LL.ot..�f <br /> Work will commence on or about 'V-/;z-/3 for approximately 120 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 /> C <br /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKWASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01/08) <br />