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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: �� � � � l� Z <br /> Date 141 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 $Of)5'2_ REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE '(4. <br /> Pacific Gas and Electric Co. VALID 7j(¢/I TO to,/5//)¢ DRIVEWAYS: <br /> STREET FrP`t(/r. fnPJ * <br /> P.O. Sox 930 AREA Q AD 5� <br /> Stockton, CA 95201 TYPE /10 <br /> FORMS f S/j �yid�_2 <br /> NOTES <br /> 2 <br /> 47 11412 /S 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 310 71011 1 q current M.U.T.C.D. <br /> Notif. 1 0-7-7 ty5-y y1 California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the side of Fe4,hck G4 YLp approximately I fee mile (�J <br /> of L lit. C K� p , .tL(r40 ft C 4 _,by performing the following work escription of work): <br /> 4(-y47, <br /> Work will commence on or about / /�/ _for approximately /S! 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 /> � y <br /> Signature of Applicant-Title Date <br /> EVUBW.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01106) <br />