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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> DateOFFICE USE ONLY <br /> To: San Joaquin County JOB# � 1 ! ��j�2 REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 10-1-20/-15— <br /> Pacific Gas and Electric Co. VALID C-Z2 /�TO ._�-Z��� DRIVEWAYS: <br /> STREET (tom NN <br /> P.O. Box 930 AREA dAL `QUAD _ <br /> Stockton, CA 95201 TYPE <br /> FORMS w �re l` <br /> NOTES <br /> �lyS' 31&— 1 ` el <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 3 115-7 3 0g current M.U.T.C.D. <br /> I <br /> Notif. I( 03 g 315 California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the S L side of f!>r U 1 l wo. R oapproximately S- 9 - ,fe /mile /V <br /> of ✓ d S 4- 1 c,4 o tZ by performing the following work(description of work): <br /> a.u-4 t t'orJ o r= S!x s' ,3-e// Nolte, �;ry 4snw4(f ) fD f-/''e iiy 5�PdJleP <br /> Work will commence on or about CP z--z- / for approximately. I qy . 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 /> Sig ature of Applicant-Title z— A As <br /> EIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC(01108) <br />