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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -$- 29 - OFFICE USE ONLY <br /> To: San Joaquin County [JJOB# Q -7,so REF# <br /> Department of Public Works N CR# <br /> P. DATE [p_ _ o I ,I <br /> Pacific Gas and Electric Co. VALID G-23-zdYTO 1v-1--2-vt-d DRIVEWAYS: <br /> STREET -�C'O.Y-&K aA a <br /> P.O. BOX 930 AREA IS16C rte QUAD <br /> Stockton, CA 95201 TYPE <br /> FORMS SN�jc.�T�,2�IT <br /> NOTES <br /> (Ara 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/D X9/ 9 current M.U.T.C.D. <br /> Notif. /p,g/58985 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 177-I side of approximately. 325 feet/f4e EAST <br /> of FiPEEn-�p,V7- c 7- <br /> W,VA performing the following work(description of work): <br /> EX f�4 cJi9 TE !/D L.E d vE2 ��0� �l'I/J lcL /1.cly CuT�d.�F CFRU/L'E <br /> PEiP/7'!/O.c/L.c/T� f9S Pl�iVLT ', PLl9Gt/�IE�iJ7- Pi 'rD!/i?ZL--> <br /> Work will commence on or about -2 3- /y' 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 /> nj�1,.0.� - <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WRIMASTERPSIENCROACHMENT PERMIT APPLICATION.DOC (07/00) <br />