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- <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -3/7c) / OFFICE USE ONLY <br /> To: San Joaquin County JOB# 61 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE i® <br /> Pacific Gas and Electric Co. VALID fo 1 4 TO / DRIVEWAYS: <br /> STREET 419j0 <br /> P.O. BOX 930 AREA --6AY7 QUAD 5F <br /> Stockton, CA 95201 <br /> TYPE -6g)-L' HoLk. <br /> FORMS W, P--2-1 <br /> NOTES q q Z- 1 S-q,7 <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 31 05-73 5 current M.U.T.C.D. <br /> I <br /> Notif. ( p-1-1c-10C)'2_q California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the N side of F• We54- lZ t P0►y 2 c( . approximately 1415 1 ee ,ile �A <br /> of k Iy(-AD IF IZ ctiZ i,p0 6y ,by performing the following work escription of work): <br /> ---E-x c 14 .4 -e I) 5 x s" B g l 1 9 01 eTo *,,e- <br /> 014+1 Va ( 5,0VJ is e . <br /> Work will commence on or about co ► l Li for approximately_ 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 /> 3 z d iy <br /> Signature of Applicant- itle Date <br /> E:IPUB-SV.WI(IMASTER.PSVENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />