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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 12 OFFICE USE ONLY <br /> To: San Joaquin County JOB# � 2-�, REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE /t <br /> Pacific Gas and Electric Co. VALID ko 3 DRIVEWAYS: <br /> STREET v/7-W 0: <br /> P.O. BOX 930 AREA QUAD A,(,$ <br /> TYPE GL i�i <br /> Stockton, CA 95201 FORMS -7-9 <br /> NOTES <br /> (209) 9412 - 1-1"5b- <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)D21204, current M.U.T.C.D. j <br /> Notif. /o 7/i9sv2 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 SouTN side of IA/1;"14 SJ' approximately 24/S feet/Aiie EAST <br /> of L3EAT,elee_ xx 4 S%DeCTOA/ ,by performing the following work(description of work): <br /> /,36o 4AIl i9 ST. <br /> Exe,4L1,472-_ <br /> GJ0,eX Til BE --'-AJ iQS^V/94_7- <br /> /�f�A. epEee/Y!i'J.JE.�/ /Q_sP/fiv[T <br /> REPL�cEvric�vl' rro 01rvc_L,0Z_>. <br /> Work will commence on or about 10- /y-13 - 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 /> /3 <br /> Signature of Applicant-Title Date <br /> E:iPUB-SV.WKIMASTEP.PSIENCROACHMENTPERMRAPPLIC4TION.DOC (OMB) <br />