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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date - q-001 OFFICE USE ONLY <br /> To: San Joaquin County JOB# I scoS a-(' REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE In•�s•09 <br /> Pacific Gas and Electric Co. VALID 9.Lz,vQ `TO ko.6•o`i DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA '5T0e_k-r6cJ QUAD ZVI <br /> Stockton, CA 95201 TYPE h, <br /> FORMS S_5/wI&s* <br /> NOTES <br /> 202)l 91q2 <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 3olot,11173 current M.U.T.C.D. <br /> Notif. California supplement. <br /> /94J'l 0AJ - S/Tc" <br /> f <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side ofapproximately feet/mile <br /> Of by performing the following work(description of work): <br /> _ Lv[.0z52 !17- 72.00 L4:),L--,X471 an1S <br /> Ty G'LE/9!Z /JEL....T �ioRyi'1 t�R.�4�n.1 L/iilE. <br /> L.y[.�Lk Fl9ciL JT E.S /3y DPE.c1 7�°�t./Cl�/�Cl�. <br /> Work will commence on or about_ 7-13-09 for approximately 1?0 days. <br /> I,the undersigned,certify that 1 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-&1,ee4'o SR AAs csnwArDie 6-LI-01 <br /> Signature of Applicant/Title Date <br /> E:IPU&SV.WWASTERPSIENCROACHMENTPEPMRAPPLICATION.DOC (01/08) <br />