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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I Qb S / OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3dp -(� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALID <br /> Pacific Gas and Electric Co. �/,3 DRIVEWAYS: <br /> T A s <br /> STREET z4 ll <br /> P.O. BOX 930 AREA G QUAD <br /> Stockton, CA 95201 TYPE plc <br /> FORMS �q/ l <br /> NOTES e l <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 3 101 -50 71 current M.U.T.C.D. <br /> Notif. California supplement. <br /> The undersigned hereby appli�s for permission to excavate, construct and/or otherwise encroach on County Highwq Right-of-Way on <br /> the side of �1f �, 1ZL-h) IZ D approximately } Z� (fe "'mile 5_ <br /> of L i"L i� L 1}�// 1J IL �-f A c r by performing the following work(description of work): <br /> 6fi 5 -S Xy i c t <br /> Work will commence on or about / /-5,-/ /3 for approximately 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 /> T-� <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br /> l <br />