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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -5- /D-/3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# C* REF# <br /> Department of Public Works APN % CR# <br /> EXP.DATE 13 <br /> Pacific Gas and Electric Co. � STREET VALID 2a 3 TOp 'S DRIVEWAYS: <br /> P.O. BOX 930 AREA QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> C.209 ?q.2- /y93 <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 3 U9'�5539 current M.U.T.C.D. <br /> Not if. /0,61.22 7-1,2 � 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 4EA Sr side of LJLigr /-/Lv`/ f? Fr_1b1V7J't„E approximately 3S0 feet/RiOe Sir!-I <br /> of C1//2/..ST/i9A/ L h� l.JY. ._S'3'D�I�TDn! ,by performing the following work(description of work): <br /> �I D 3 AJ. A/1,L)Y 9 9 <br /> EX C14 L1.1/9 r'E /-SOLE O[JEiZ 64S /Y!A11,/ AA/A CuTU/Cc. <br /> AL �L 201EK 7-0 BC 1�o,yt -TA.1 L-)/2 T A 1Z A . <br /> Work will commence on or about S 20 -/3 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 /> n <br /> Signature of Applicant-Title Date <br /> E.IPUB-SV.WKWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01/08) <br />