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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To:. San Joaquin County JOB# 3CcSz— .-REF#- <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> Pacific Gas and Electric Co. VALIDDRIVEWAYS: <br /> STREET 5 �be <br /> P.O. S®X 930 AREA L UAD LV <br /> Stockton, CA 95201 TYPE <br /> FORMS S WW <Z <br /> NOTES <br /> 4 3/4 - 17(,-7 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailedplans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per <br /> PM3115:S s-/b current M.U.T.C.D. <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 SDUTN side of SE!//LL'' '0 /C approximately. 23 Y feet/a4e E/4si <br /> Of– J3'4L 13Dr9 /91/E , —by performing the following work(description of work): <br /> /�/�3 SEviLlc NvE. <br /> E�cc�vv/�r� /IDLE ovF1Z �i4S /YIi4l,t! Ai�l1� Ct,�T oFF SEJZ!//G � . <br /> /'E2�ii.c/ivvh/T /�sPr/s911 ,t'EA�sUI�n�G;clr r <br /> Work will commence on or about � - .?9-/S" - for approximately 90. days. <br /> 1,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 /> O� Signature of Applicant-Title Date <br /> E:1PUB-SV.WKIMASTEP.PSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br />