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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date //- q /3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 30 G? !F 2-r REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 3- 1- 14 <br /> Pacific Gas and Electric Co. VALID ('Z-Z�1; TO -I (¢ DRIVEWAYS: <br /> ASTREET S <br /> P.O. BOX 930 AREA 5AvAtoh QUAD N E <br /> Stockton, CA 95201 TYPE Bellhple <br /> FORMS Ssf'wi✓ -� 92 3 g00 <br /> NOTES <br /> (20q) 9y2 - /yf o <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 31033579 current M.U.T.C.D. <br /> Notif. �0�3��90v 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 EAST side of_,S 7A/LU1k1,C- TT! LIJ approximately W feethmiM AlnerN <br /> Of MIS TL, T5 1944E .STOGA'TOA/ ,by performing the following work(description of work): <br /> 22 0 /YI 1-5 TL ETOE - A/DUSe ry 13E / JYIUG lS/ � <br /> EJCGj9Ul�41'� /SOLE DUE.2_�,/4S 171 41A/ .4A/6 C[47' <br /> tJo,eK ry BE o,vE Ih1 <br /> 4S P141kT <br /> I"eA 7- 7I ICU LL OGcJ, <br /> Work will commence on or about /,2- 2- /-3 for approximately �D 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 /> -12 <br /> Signature of Applicant-Title Date <br /> E:1PU&SV.W10MASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />