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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: P S 14- 004-012 <br /> Date 2 -.2 P ?0 . 2677t <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID � TO DRIVEWAYS: <br /> STREET Bin <br /> P.O. BOX 930 AREAS+moo kloy) QUAD L.V <br /> Stockton, CA 95201 TYPE s 5��yy' Q <br /> FORMS <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 3pgz�, Z1 current M.U.T.C.D. <br /> Notif. SvS-Bgo�s� California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Riqht-of-Way on <br /> the side of B,&j 1mz r&R-1 <br /> Jf iv,sly <br /> -5'Z1 A-WOA! by performing the following work(description of work): <br /> IZEMDUE 19AZA RC"kI9CE EXlsi i c/� <br /> . TREET �1�/�j�QG2Tiv /� 41 /Cs <br /> Work will commence on or about for approximately <br /> 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 /> Signatuffi of Applicant-Title <br /> Date <br /> EAPUB-SV.WKWASTER.PSIENCROACNMENTPERMITAPPLICATION.DOC (01108) <br />