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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date I -/5-/l/ <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 />�.?Oqi 9142- /V 5'3 <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 3/US"75,99 current M.U.T.C.D. <br />California supplement. <br />Notif. /a�S22218 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Sour// side of LY.VAJ-c' Rl- , approximately /S'7- feedm4e <br />of 7.1.15 7;e4c---/ , by performing the following work (description of work): <br />EX Gry l/l J i C ��DL E GUE� 14AS IWIVIAI /4A1[ -J CuT' <br />Work will commence on or about 4; - ,2 - /y for approximately 9D 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 />Signature of Applicant - Title Date <br />EAPUB.SV.WKU9ASTER.PSIENCROACHMENf PMWAPPLICATI0N.000 (01106) <br />Y <br />OFFICE USE ONLY <br />JOB # <br />Yw - 75OC62^L REF # <br />APN <br />CR # <br />_ <br />EXP. DATE — 2v i L4 <br />VALID <br />6-7-.7 V TO -/ -Z p DRIVEWAYS: <br />STREET <br />L„� (d <br />AREA <br />QUAD <br />TYPE <br />- t "'Cye-,� '\' _ <br />FORMS <br />ewGln. e 1 v` <br />NOTES <br />Tt,)+ f <br />Traffic Control Plan <br />See attached sketch. Shall be as per <br />PM 3/US"75,99 current M.U.T.C.D. <br />California supplement. <br />Notif. /a�S22218 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the Sour// side of LY.VAJ-c' Rl- , approximately /S'7- feedm4e <br />of 7.1.15 7;e4c---/ , by performing the following work (description of work): <br />EX Gry l/l J i C ��DL E GUE� 14AS IWIVIAI /4A1[ -J CuT' <br />Work will commence on or about 4; - ,2 - /y for approximately 9D 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 />Signature of Applicant - Title Date <br />EAPUB.SV.WKU9ASTER.PSIENCROACHMENf PMWAPPLICATI0N.000 (01106) <br />Y <br />