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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 2 -19 - 1q <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 />(2vg) 9112- /ygg <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 31057-TD3 current M.U.T. C. D. <br />Notif. 10 X822 z 16 1California supplement. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EA Sr . side of G//iQ%.941AA-1 2.h approximately 5.20 feedffiile So"7W <br />Of Li AJAJE XL T24cy , by performing the following work (description of work): <br />E.)LCrO LIA 7-,C /-1DLE Dut R &-AS I"IVIAI /gnly OFF SE2r//cam . <br />/4LL LJVRK 7D 13C L)QAtZ ZAY .41RT AA?629 - <br />Work will commence on or about 3 - /0 - /,/ for approximately 4, o 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 />LAS 81D.4— <br />Signature of Applicant- Title Date <br />E.iPUBSV.WKVAASTERPSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />OFFICE USE ONLY <br />JOB# <br />REF# <br />APN <br />CR # <br />EXP. DATE <br />O/ <br />VALID <br />• —10 - 4TO DRIVEWAYS: <br />STREET <br />* <br />AREA <br />QUAD S <br />TYPE <br />%ft. - <br />FORMS <br />ssfeu% <br />NOTES <br />Traffic Control Plan <br />See attached sketch. Shall be as per <br />PM 31057-TD3 current M.U.T. C. D. <br />Notif. 10 X822 z 16 1California supplement. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the EA Sr . side of G//iQ%.941AA-1 2.h approximately 5.20 feedffiile So"7W <br />Of Li AJAJE XL T24cy , by performing the following work (description of work): <br />E.)LCrO LIA 7-,C /-1DLE Dut R &-AS I"IVIAI /gnly OFF SE2r//cam . <br />/4LL LJVRK 7D 13C L)QAtZ ZAY .41RT AA?629 - <br />Work will commence on or about 3 - /0 - /,/ for approximately 4, o 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 />LAS 81D.4— <br />Signature of Applicant- Title Date <br />E.iPUBSV.WKVAASTERPSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />