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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# _ 73 0 65 REF#- <br /> Department of Public Works APN _ CR# <br /> EXP. DATE <br /> VALID 1>-i( TO DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET <br /> P.O. Box 930 AREA AW QUAD <br /> TYPE F <br /> Stockton, CA 95201 FORMS '>SL✓h/ Z <br /> NOTES <br /> f 2 o1) 9Y2 '1,198 <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 31/Y83 q1 current M.U.T.C.D. j <br /> Notif. 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 EAS r side of 41XA)R7' LA.,v/4`1 approximately 833 feet*• 14 orTl-/ <br /> of L-,gny 2 o)D Rz , /Y AA17W1A ,by performing the following work(description of work): <br /> ,xc,a v.4 r6 /.101-4 0VC9 LAS M I/Al AYLA7 GuT' af-F s,eRL11 5. <br /> 1211 WD9K Ty AC 1)ok/E ZAI 811.7- 1912W. <br /> Work will commence on or about ��//-/� _for approximately 170. 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 /> 1-,S A. LE, <br /> Signature of Applicant-Title Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />