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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4-13'13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ilh//; <br /> Pacific Gas and Electric Co. VALID z3 )� 0 J DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA Qu D <br /> TYPE D Al �I19 <br /> Stockton, CA 95201 FORMS <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 31021203 current M.U.T.C.D. j <br /> Notif. /o-�:119g8; 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-EA S? side of 7-11EL,P"11 LAE approximately 2.3c7 feet/rRk So(-,72,1of Z)19AI�q /at/E by performing the following work(description of work): <br /> /a3 QS. TNEL JYl/1 ra rJ�. <br /> FX C14 LZA 7-E AIvL—` Ou C2 6 AS 074//J 6 ,14 CUT' OFF SES IJI GL <br /> G)D2K Tv LI01,.4Z XV 1QsP/1I4LT 4RCA <br /> MzW7- Tv --0LLQZ-J. <br /> Work will commence on or about An -21-13 for approximately 9D. 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 /> Signature of Applicant-Title Date <br /> E:kPUE-SV.WKN STERPSIENCROACHMENT PERMIT APPLICATIONAOC (01100) <br />