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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3 - G - IN <br />To: San Joaquin County <br />Department of Public Works <br />Pacific Gas and Electric Co. <br />P.O. Box 930 <br />Stockton, CA 95201 <br />(2og) '711.2 -/119$ <br />(Afea Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />See attached sketch. <br />PM 31D59 -I.Sq <br />Notif. /o 7233 SBL -/ <br />OFFICE USE ONLY <br />JOB #— 73C?'�SZ 6 REF # <br />APN CR # <br />EXP. DATE '�--1-2ol q <br />VALID 3-2y— v TO DRIVEWAYS: <br />STREET <br />AREA <br />TYPE <br />FORMSt <br />NOTES <br />Lel Q AD <br />V No <br />Traffic Control Plan <br />Shall be as per <br />current M. U. T. C. D. <br />I <br />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 Sourg sideof Lj, L.;IoDaagrL)LE 21-� approximately 2330 feeV4:Re EnST <br />of L)1901S kL , I Lo b i. , by performing the following work (description of work): <br />ESC ��inrr€ MOL,5 ouElZ i 741xl AAtLi cuT o.�F s�2vic� <br />/9L L LJn2K TO /35 1�, DAXE - cl L) i )LTA /Y of , <br />Work will commence on or about 3- 211--/,/ for approximately 90. 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 />0,, ZL"Zei�i — G14S /9. j -s. E. <br />Q( Signature of Applicant - Title <br />E:1PUB-SV.WKWASTER.PSIENCROACHMEN, PERMIT APPLICATION.DOC (01/08) <br />Date <br />