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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5- 943 OFFICE USE ONLY <br /> To: San Joaquin County JOB# �.? Z-Cp REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE ) 1 <br /> Pacific Gas and Electric Co. • VALID � �? t T 1 )� DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA pts QUAD �[ <br /> TYPE #466 <br /> Stockton, CA 95201 FORMS ww zg <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 3Dg95325 current M.U.T.C.D. j <br /> Notif. lOG gZ / Yyy 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 .SDUrIV side of RL , approximately 780 feet/044 z A S T <br /> of /114 41,J Lit./. /?C lq!??PO ,by performing the following work(description of work): <br /> 3535 �. [�Dvt�L`�1Ql�G,� R1J. <br /> c X G A tJiq TE' NO LE o uZ 2 GAS X>1,-9 ti/ Tv cv 7- <br /> At-L- <br /> ALL_ LJo,EK To �3,C Dpti45 _ru D IR7- eq e ,g <br /> Work will commence on or about S- 13 for approximately 9D _ days. <br /> 1,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 /> LA_S /Abz S- q -13 <br /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT APPLICATION.DOC (01108) <br />