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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date a- 2 � -D':� OFFICE USE ONLY <br /> To: San Joaquin County JOB# 1Z,& REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE rj, 1=09 <br /> Pacific Gas and Electric Co. VALID '3•Z o'9 TO Z•1.®5 DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA Stec k:T+a 0 QUAD ES ` <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. Shall be as per i <br /> PM yl0q.231y current M.U.T.C.D. <br /> Notif. /03,6;Z5I�7l California supplement. <br /> FU/C fiAJ I-/ C,Aj- <br /> L—WA-J <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the .SU al-/i side of_E. 12MRSN -S? approximately 2c18 feet/%* Z19-,97- <br /> of l�Ii9L l CE2 L ti/. .SKNOV by performing the following work(description of work): <br /> IA./ D/eL�C2 To ST ZZ- <br /> Al Zif ZSSiV2y TU XCL4cJi9TE C2 5'x y' l3LLL /�/OLCS' /�.c/p DPc,c! <br /> Work will commence on or about: /nr9/�/-1 for approximately 9D 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 /> R Z; srir jl720R 2 -27-D`� <br /> Signature�Appl�icant-Title Date <br /> E:1PUB-SV.WXMASTERPSIENCROApiMENT PERMIT APPUCATIOKDOC (01108) <br />