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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date G /2-/3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 730052 REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE I 1 -1 -1 S <br /> Pacific Gas and Electric Co. VALID f-1 -1 TO ((-( -(S- DRIVEWAYS: <br /> STREET A L4,419 74 _ <br /> P.O. B®X 930 AREA i QUAD <br /> Stockton, CA 95201 TYPE Uhole <br /> FORMS 5 WW R 29 <br /> NOTES <br /> ZDf g1Y2-/y913 <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 /S 93 9S current M.U.T.C.D. j <br /> Notif. /io yZ/o32 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 ,E/9S7- side of 14 'o 19LJE• approximately 24A feeYQ;AQ Soze,-f! <br /> of FLOlZ/Y]A M E. , STDGK7'o.C/ by performing the following work(description of work): <br /> 2oio /9t.�Tb AvE. <br /> EX civvsgr'E r14)LI oU%52 40S AlAIA! 11A/10 4,17- p,cc sE.evicE. <br /> Work will commence on or about I.- 29-IS for approximately 90 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 /> 0 Signature of Applicant-Title Date <br /> E:IPUB W.WKIMASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />