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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date //-/-3 - /y OFFICE USE ONLY <br /> To: San Joaquin County JOB# �P -SWS2-,a--REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID L2-$r Z� TO 3�/S�Zu! DRIVEWAYS: <br /> STREET _`�\ X� Q <br /> P.O. Box 930 AREA QUAD KS� <br /> TYPE <br /> Stockton, CA 95201 FORMS <br /> - NOTES <br /> .209 91.2 - <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shaill be as per <br /> PM 3 jjlyygs- current M.U.T.C.D. j <br /> California supplement. <br /> Notif. �o94�s-9G3 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the A/OIP-7'f1 side of LJ. EL approximately /'V5" feet/4f8 E.4S7- <br /> of RA R41 LDD! by performing the following work(description of work): <br /> CXcrJu�9T� /�D[�. arJC2 LAS miO�.J Ai✓�� CuT OFF S�2ylc C <br /> /9LL WORK 7`D 26 —MLI -41112 T /-71Z,,5A. <br /> Work will commence on or about 12 -c3-/q _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 /> a41 -13-!,2� <br /> Signature of Applicant-Title Date <br /> E:1PUB-SV.WKWASfER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />