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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73-0 V !F Z REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID L0 _ 14 TO Q -1 •(c" DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET Cotep*ier Ad <br /> P.O. ®®x 930 AREA QUAD �F <br /> Stockton, CA 95201 TYPE kA Vp <br /> FORMS, Z� <br /> NOTES <br /> L,20gj 9112- P-1' 99 <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 31111 Y33 " current M.U.T.C.D. j <br /> Notif. /09593//9 California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the AIDRJ'f/ side of Ci42PF�/TE2 2D. approximately /1015 feeUR41e L-14.ST <br /> Of mly2PoSio 2A Sib�K7'o.� ,by performing the following work(description of work): <br /> ,EY-,CA LIA 71E IYDLE' 0 vE2 LAC MAW IVAIy !f"7- <br /> 4Z-L- <br /> '"4Z-L- 43d91< Ty t& t]pn.IL Z"- tLi27— 1OfL,:5-A , <br /> Work will commence on or about 11 -211- 111 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 /> — LAS A. /D - Zu-/4 <br /> Signature of Applicant-Title Date <br /> E1PUB-SV.WKUWASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />