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L_ i 1, i1 i� N f- rC- IVl, iClJr-1 C-1 I',; <br /> DATC <br /> TO: SAN JOAQUIN COUNTY HIGHWAY DEPARTMENT OFFICE U S E ONLY <br /> JOB N--------------------- REF M --------- <br /> P G 8 E CO. APN ----------------------- CRV # --------- <br /> (APPLICANT NAME) EXP. DATE----- --------------- <br /> P. 0. BOX 930 VALID---------TO------------- DRIVEWAYS: <br /> (MAILING ADDRESS) STREET --------------------- ----._------ <br /> 3 i ` v 'i, 1, � 9520 1 -------- --- <br /> - '_ - <br /> iTPE ------------------------ ----------- <br /> (CITY, STATE ZIP CODE) FORMS ----------------------- <br /> 942- 1 528 NOTE ------------------------------------- <br /> (ARER CODE - TELEPHONE NUMBER) ------------------------------------------- <br /> ------------------------------------------- <br /> THE PG & E. CO. HEREBY APPLIES FOR PERMISSION TO EX VATE,IONSTRUCT AND/ OR OTHERWISE ENCROACH ON COUNTY <br /> HIGHWAY RIG - -WRY ON THE��3�___SIDE OF __ ,Gt� __4 4:f!_____________________APPROXIMATELY <br /> ,,t til Y AI/� . <br /> 3 FEET MILE !_ OF____________________________________, TBY PERFORMING THE <br /> FOLLOWING WORK: <br /> INSTALL ❑ DEMOLITION ❑ MAIN & SERVICES <br /> ❑ REPLACE ;& GAS C. SERVICE ONLY SERVICES --K- EA. <br /> ❑ REPAIR ❑ ELECTRIC U.G. ❑ MAIN ONLY <br /> ❑ ABANDON ❑ COUNTY PUBLIC WORKS PROJECT TRENCH LENGTH--_-l3----FT. <br /> SURFACE TYPE: f9 NATIVE DIRT ❑ GRAVEL ❑ PAVEMENT <br /> TYPE OF TRENCH 2 BELL HOLE ❑ BORE--6" OR LESS ❑ SPLICE BOX <br /> ("� TRENCH ❑ GAS REGULATOR BOX � <br /> GENERAL DESCRIPTIO : _.�/_Y.Sl� _, R----- --- -T-- � - <br /> TfC ---� a __-J�!�c--- OqEt-------------------------------------------- <br /> ------------------------------------------------------ ------------------------------------- ---- <br /> PROPOSED START DATE_____ __ r_95______ PROPOSED COMPLETION DATE:_-—_ =9 ----------- <br /> S <br /> ____-_____ <br /> SKETCH <br /> 4< <br /> �F�Yicd <br /> G <br /> } <br /> ------------------------------------------------------------------------- <br /> ------------•------------ <br /> P.G. & E. JOB REFERENCE Nl1MBERS: S.0. 0 0731 Zo38v E. BOUTTE, DIVISION MANAGER <br /> SR t`f- CG--- ---BWO---4_E-d-4- <br /> WO--GM -------- ---------- BY �'�- --- C•Q! S!Z1-j1V <br /> ACCOUNT_7Z�--_-_____ SUB ACTIVITY ___�Sv____ GAS / ELECTR GENERAL FOREMAN <br /> ACTIVITY _______________ SUB ACTIVITY _______________ CONTACT PERSON PHONE_.T'A?-_L✓&l__ <br /> •--------------------------•------------------•------------------------•----•--•---------•---•---- <br /> RETURN TO: 9ffe. /7�-3 <br /> ❑ ATTN: T/0 GENERAL FOREMAN ❑ ATTN: T/O GENERAL FOREMANATTN: CONST. & MAINT. DEPT. <br /> P.O. BOX 1032 P.O. BOX 330 Pl-P.0. BOX 930 (BLO'G 2) <br /> MANTECA, CA. 95336 TRACY, CA. 95376 STOCKTON CA. 95201 <br /> OFFICE OFFICE OFFICE <br /> PHONE: 942-5092 PHONE: 942-5012 PNnNE: 942-1401 <br />