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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date I / 4 I OFFICE USE ONLY <br /> To: San Joaquin County JOB# �i �:��sZ-� REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE P <br /> VALID TO <br /> I-gyp�.� DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET A <br /> P.O. BOX 930 AREA <br /> r3'frs�Zt env---QUAD NF <br /> TYPE 2 �, <br /> Stockton, CA 95201 <br /> FORMS s-`�/lam ���.,.��..rpa►- <br /> NOTES <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 IV!3, D7� 7 current M.U.T.C.D. <br /> Notif. i p 17 7 tQ 117 � California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County High v !y Right-of-Way on <br /> the A-,4 side of A-iZ4 '-4Z D approximately 1303 Meed ile l O <br /> of I'z by performing the following work(description of work): <br /> ,fe Xcs✓t4k Z ) q 13-e <br /> 14-L,df t". 51-141 I r1��.� 5t✓✓ C� <br /> Work will commence on or about -71317141 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 /> z� 2 <br /> Signature of Applicant-Title Date <br /> E:IPDB-SV.WKIMASTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC (01/08) <br />