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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date q- IS - 13 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE / <br /> VALID )3 TO // DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET "8 ✓r <br /> P.O. BOX 930 AREA Jackr&J QUAD $� <br /> Stockton, CA 95201 TYPE "be U— 14 oto <br /> FORMS <br /> NOTES <br /> (20q) 54/2- /t/48 <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 SIOZ1209 current M.U.T.C.D. j <br /> Notif. /07// 9SD6 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- EAE T side of .S. ",3" S77-zE2 T approximately 16 feet/r44e A/a. r,41 <br /> of B r ST S72�,c.47'an/ by performing the following work(description of work): <br /> Zxc4L--1,4rE N0LZT 0uE,2 .-4S mgl,v AAJ6 cur oFF sE,ev�cE. vo,e.� <br /> To Z� Pry cJCLI A,2EiQ. P�.2�z�iq.v�,c�T /JS P�✓arc r P�.vc��r� ; <br /> TIS FvL L OL1 <br /> Work will commence on or about /o - /y- /3 for approximately So. 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 /> 0. <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKWIASTER.PSIENCROACHMEHT PERMIT APPLICATION.DOC (01109) <br />