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�r <br />APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date ') - /I- /y <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 />�v 9'Y2 - /y9� <br />(Area Code - Telephone dumber) <br />itch (Detailed plans may be submitted) <br />Traffic Control Plan <br />See attached sketch. Shall be as per <br />PM .3/057/51 current M.U.T.C.D. <br />Notif. �oz���522 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 LJEs f side of P914.5 r .A6 approximately /Sb feet/vAe .voer'i� <br />of iam7' cT: r/rfr.- lZy1!9c7) f,P6U&1 44M)0 by performing the following work (description of work): <br />Work will commence on or about 3 -lo -1-1 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 />lI� IL,tj_ �� - LAS 4.6.,E. .2 -1? -Il <br />Ol Signature of Applicant - Title Date <br />EAPUB-SV.WMMASUP PSIENCROACHMENT PERMIT APPLICATION.DOC (000) <br />OFFICE USE ONLY <br />JOB # <br />-6Q(KZ--;CREF # <br />APN <br />CR # <br />EXP. DATE <br />-Zr-2- 0 1 Ll_ <br />VALID <br />Z-1 O -Zy IyTO^(,S 2� 1.,1 DRIVEWAYS: <br />STREET <br />AREA <br />�ae UAD_ <br />TYPE <br />FORMS <br />NOTES <br />SS /WW <br />itch (Detailed plans may be submitted) <br />Traffic Control Plan <br />See attached sketch. Shall be as per <br />PM .3/057/51 current M.U.T.C.D. <br />Notif. �oz���522 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 LJEs f side of P914.5 r .A6 approximately /Sb feet/vAe .voer'i� <br />of iam7' cT: r/rfr.- lZy1!9c7) f,P6U&1 44M)0 by performing the following work (description of work): <br />Work will commence on or about 3 -lo -1-1 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 />lI� IL,tj_ �� - LAS 4.6.,E. .2 -1? -Il <br />Ol Signature of Applicant - Title Date <br />EAPUB-SV.WMMASUP PSIENCROACHMENT PERMIT APPLICATION.DOC (000) <br />