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I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date - y- /5 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> Pacific Gas and Electric Co. VALID �.2-20/-),To .�,�5-- DRIVEWAYS: <br /> ' STREET <br /> P.O. BOX 930 AREA QUAD t� <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES / <br /> 209 - 9y2, - /Z/lt3 <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 311 S zqW? current M.U.T.C.D. j <br /> Notif. /0 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 AMRT/-1 side of SPEiAL� 4Ale . approximately /!y feet/44e ZEAS' <br /> of rnjt /DA/ g0 Lo is i ,by performing the following work(description of work): <br /> yS/ S f;21AJi!42 Lill <br /> y�C C�4 tJ�4 rE /EDGE ocl,6,e Z S /"/V//L! IVA) GuT ©FF S�2ys <br /> �'�'2�li9iv��/T s9s�r/��r REPL�ocE��,crT Tv �v�L vcv. <br /> Work will commence on or about 3-.2-IS for approximately _ 9r�. 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 /> E1PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC(01108) <br />