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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 9- 2- -0 9 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7__3fpC:> 172-49; REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE I— l_ZCO c <br /> Pacific Gas and Electric Co. VALID TO i- - DRIVEWAYS: <br /> STREET <br /> P.O. BOX 930 AREA '-`cY QUAD '_3 <br /> Stockton, CA 95201 TYPE <br /> FORMS S W <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 <br /> PM 1-/I yy95--5 current M.U.T.C.D. <br /> Notif. 102'' California supplement. <br /> I <br /> /-/I if r <br /> .ZSSUCS <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the A10lZTH side of CLoLIE,R 1M. approximately 31& feetl*+le ,E09s 7- <br /> Of Cc:PXA'L 14az.[.01.J RD. _M$*--y by performing the following work(description of work): <br /> _rAl AC)112 i /Qp F...i4 Tv <br /> f AIAJiEA-/p uCc o v G4S 7-ISS. <br /> Work will commence on or about /"Y-SZ5P-0 19, for approximatelygo 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 /> 1� eta �s in��roR 9-z-dg <br /> Signature of Applicant/L Title Date <br /> EMU&SV.WKWSTER.PSIENCROACHMENTPERMD'AWUCATIDN.DOC (0110S) <br />