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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ;? /.3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73r, 2-� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE #A; <br /> Pacific Gas and Electric Co. � VALID z� �� 0 ///?//3 DRIVEWAYS: <br /> STREET 177 <br /> P.O. BOX 930 AREA QUAD <br /> TYPE <br /> Stockton, CA 95201 FORMS s �� z9 ✓� �� <br /> NOTES <br /> 2vC 9412- 1q,93 <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 210-2/2D7 current M.U.T.C.D. j <br /> California supplement. <br /> Notif. !o 7/i qs-03 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SDUTN side of approximately `/9S feet/rR+le EAST <br /> of `13" ST/tEEJ' S;0,=ZroiJ by performing the following work(description of work): <br /> 20 7 0 E. 1 r' ST. <br /> Exclq L1,4 rr 1"A/,/ 1-7.cly cur <br /> JA-1 /'�►�P/1fi9�T pP Ego 0,c -S/ 1��1c�s�✓��c/T As elm e-r <br /> 2�PL/ocErr/c .yr rD .coz-1-,0W. <br /> Work will commence on or about lo- 1,1-,13 for approximately Fa 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 /> r ' <br /> el <br /> Signature of Applicant-Title Date <br /> E:1PUB.SV.WKIMASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC (011081 <br />