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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# J?, 10 SZ- REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE / 13 <br /> Pacific Gas and Electric Co. VALID TO 1 DRIVEWAYS <br /> : <br /> STREET <br /> P.O. BOX 930 AREA -7"- ey QUAD 5W <br /> TYPE BELL qnt� <br /> Stockton, CA 95201 FORMS 4,' 2,5 <br /> NOTES <br /> 2zoq -- a5clq <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 S M)6-75` current M.U.T.C.D. j <br /> California supplement. <br /> Notif. i b7 C)C1 yag <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the W side of (nA.A crTL ore- lz D approximately ( -1- fee mile w <br /> of L RVI a 0 2 /3 ►� by performing the following work( escription of work): <br /> KG✓ L)44 F— C0 41 y" I3c/1 /�o%P -I-1S ./°ie-vuiJ s ev -e <br /> Work will commence on or about for approximately 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 /> SI�2 7A3 <br /> Signature&AppllcdiA-Title Date <br /> E1PUB.SV.WKIMASTER.PSIENCROACHMENr PERMITAPPUCATION.DOC (0110B) <br />