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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9-Is- /3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# �, ��� REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /t 1 la <br /> Pacific Gas and Electric Co. VALID a 0 j3 DRIVEWAYS: <br /> STREET ' <br /> 'or, <br /> P.O. BOX 930 AREA d QUAD <br /> Stockton, CA 95201 TYPEFORMS S w, Z21, <br /> NOTES <br /> 2vq91-12- <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 t D 212 D B current M.U.T.C.D. <br /> Notif. /07// <?5,01 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 EAS7- side of `23 approximately 3 q0 feet/nae A/oer/-1 <br /> of 5 -57'0C-16 oi,G by performing the following work(description of work): <br /> 2156 S. `SLB." Sr <br /> E�C.4✓.4 7 e 14DLEy 4J 45 L IAS /YIIJVA/ &J L CL47- DF,C SEA 1AC E- E�CGA rJ/�t'/Ji 6 <br /> Ty Dccc..lZE Zt( P`0L&5-1! 25147' ALS1ZMAA.1 5VZr A-P%de-r <br /> Tv FoGGoW <br /> Work will commence on or about /o -/y-/3 for approximately 9a 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 /> 6,4s <br /> Signature of Applicant-Title Date <br /> E.XPUB-SV.WKV.AASTERPSIENCROACHMENEPERMRAPPLICATION.DOC (01108) <br />