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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 3 t'3 /1 Lf <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 />,3zY— Sg47 <br />(Area Code - Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Seeattachedsketch. <br />PM 30 8 9 16-7,5- <br />Notif. l O SSg?1-T3c> <br />�/J� OFFICE USE ONLY <br />JOB# CTc� Z5Z6-2-c- REF# <br />APN CR # <br />EXP. DATE e;-1— 2,p / . J <br />VALID 1-1-1-2oVATO G -1-2o1 DRIVEWAYS: <br />STREET "�, St <br />AREA <br />TYPE <br />t-c'r QUAD <br />FORMS <br />NOTES <br />. Traffic Control Plan <br />Shall be as per <br />' current M. U.T. C. D. <br />California supplement. <br />5th eo <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the rjoryrk side of MAS approximately 3to 'Laggffl�1e <br />of F by performing the following work (description of work): <br />R-taock-r� it c Ac.--r9pc-- r --,W- Tint£ <br />MA-rN 9-r12-cyr 13��ol�G PRvJE a r <br />Work will commence on or about `f( /ML — <br />for approximately 3a days. <br />1, 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 />- 5 12- - pa -0i azi- V, <br />Signature of Applicant - Title <br />EAPUBSV.WI(IMASTER.PSIENCROACHMENT PERMIT APPLICAT10N.00C (01108) <br />S[3/Iy <br />Date <br />