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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date to -.3 - 1Y OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7 3 Q REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE ([- - �f <br /> Pacific Gas and Electric Co. VALID 7-24-/� DRIVEWAYS: <br /> TO ( - ( -( � <br /> STREET 1V <br /> P.O. Box 930 AREA UAD 1�/s <br /> TYPE Belthate <br /> Stockton, CA 95201 FORMS SS/WW 1?2-9' <br /> NOTES <br /> (ao 9) 9ya - ly9B - <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 31050013 current M.U.T.C.D. <br /> Notif. 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 A/dRTN side of LJ. &MSI-I/n/L70At Sr, approximately BZ feet4 e LLJEST <br /> of LDS IgAILELES , S7*041020A/ by performing the following work(description of work): <br /> /8/5 W. WAsN[tiILTDAI ..ST <br /> EXc14017E NDLZ QL E2 Q9S IV41Al AAJD eLw off <br /> ALL Lip" ro B.X' 1610AXE rc! L.,er /We/q . <br /> Work will commence on or about 1. -.23-111 for approximately 9D 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 /> �- Signature of Applicant-Title Date <br /> E:NUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01/OB) <br />