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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 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 (-1-2e) TO — I_ / DRIVEWAYS: <br /> STREET t\011A <br /> P.O. Box 930 AREA -1 <br /> v'-QUAD <br /> _ <br /> Stockton, CA 95201 TYPE <br /> FORMS SS v)t,J <br /> NOTES <br /> _209 <br /> rea Code•Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM current M.U.T.C.D. <br /> Notif. /!p/D3oG y 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 L•�A7<r side of 1JggLE.41 Rb approximately feet/+41a Soi,IY/,f <br /> of //0SrP/7i4L 2D. F,e=cy 419M,0 ,by performing the following work(description of work): <br /> F�(c!4[Jiv TE �/vLE DVL-2 GAS fV <br /> PE2 e_"4 _1 7' 6_T,0,/14 LT SEP �4�`c�yj-��T 7b Fa /�7e.7 <br /> 'Work commence onor about y-2D-/S for approximately 4D 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 /> E1PD&SV.WKVAASTER.PMENCROACHMENT PERMIT APPLICATION.DOC(01108) <br />