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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date D GL , Z�'V , 20 OFFICE USE ONLY <br /> To: San Joaquin County JOB# '15c5o sZ—G REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /S% 2tjl W <br /> Pacific Gas and Electric Co. VALID TOS-IS-2U1DRIVEWAYS: <br /> STREET (J,-) <br /> P.O. BOX 930 AREA ,p�1t QUAD N <br /> Q,�\�\ <br /> Stockton, CA 95201 TYPE FORM ,,} <br /> STm'Ck <br /> NOTES <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 --'301 DQ-zn� current M.U.T.C.D. j <br /> Notif.IC)-75Z(OZ74 � California supplement. <br /> I <br /> The undersigned hereby applies per fission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of . A(-AM 117_ approximately ( �J5 f feetimieFEE_ <br /> of �<.AMpT p ,by performing the following work(description of work): <br /> 5EOGD EL„ � fC�ce :TIC l �LAGE e . <br /> J <br /> Work will commence on or about for approximatelyC- days. <br /> I,the u s ned,certify.that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> wo des ed above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval., <br /> Signature of App icant-Title Date / <br /> EiPUB&SV.WKIMASTER.PSIENCROACHMENTPERMfr APPLICATION.DOC (07!06) <br />