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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE Oct <br /> Pacific Gas and Electric Co. VALID v TO �� pq DRIVEWAYS: <br /> STREET act'a,,�tr�.n�o t2A. <br /> P.O. BOX 930 ` AREA S6ck+0?\ UAD <br /> Stockton, CA 95201 TYPE -Trte,,c N -t- <br /> FORMS <br /> NOTES <br /> (2D 9 9 yz - /y 9v <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 current M.U.T.C.D. <br /> Notif. /D33/B.S-82 California supplement. <br /> cDAv rvc r RA&(L;/ <br /> zotjR K `106 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the LA 7- side of z-oLJE,4e S194,2 n zC-AilD R.6 approximately feet/mile AloRT-N <br /> of TOA. by performing the following work(description of work): <br /> ZAJS7 4LL 1610 1c7"- yF .VtW L;AS An4lkl BY OP�A./ 7-9EAu'c1-11AJ /only <br /> /ZE PLALE ThfE (2) Z,/4S SEKIJ/GES D.tJ 721, G�1ES t` <br /> D/c Z-LJ2 Sp 2c�L� LJ AL L 8E BD2E1� [Ua/I�E�2 7*d5 ROAIi. <br /> Work will commence on or about_ 3-nuL, -09 for approximately 40 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 LA "S7"I726R Zo' ©9 <br /> Signature of Applicant-/-Title Date <br /> E:IPUBSV.WKNMSTERPSIENCROACHMENi PERMRAPPLICATIONDOC (01MO) <br />