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E i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT; <br /> Date O _ 0 <br /> OFFICE USE ONLY <br /> I o: San.Joaquin County <br /> Department of public Worcs JOB# 73�K5� REF# <br /> APN CR# <br /> EXP,DATE , Og <br /> P.G. &E. CO. VALID O9 TO ,IS• X317 DRIVEWAYS: <br /> 4040 REST L4NE STREET MsrrL® �' <br /> o / "`^D <br /> AREA QUAD <br /> STOCKTQN, CA 95204 TYPE <br /> FORMS _ <br /> NOTES <br /> -.942 - 13-1 <br /> (Area Code-Telephone Number) --- - <br /> Sketch(Detailed plans may be submitted) <br /> See attached sketch. Traffic Control plan <br /> PM 3© � Shall be as per <br /> 4- <br /> Notif. 10 Z-. current M.U.T.C.D. <br /> 1 3 California supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on CountyH' <br /> the N-- rZt'XA '5100 of G. (�. ��.ri�rn" '� ,-., <br /> Of approximately 3 � rgfrwa Right-of-Way on <br /> ee iie <br /> by performing the following work escription of work); <br /> Work will commEncP on or about_ I }r; p„ <br /> --- For approximatelyM `� I <br /> I, the undersigned,certify that I am the owner of the respectiveproperty, �� <br /> work described above in accordance with the rules and regulations of San Joaquin County and subjectt t <br /> p or am qualified to represent the owner and agree to do the <br /> to inspection and approval.. <br /> rgnature of Applicant•Title <br /> d <br /> Date <br /> �,Waor�:ro,ro� <br />