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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date f0-/3 -L7c OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73o6-5Z- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE l •to <br /> Pacific Gas and Electric Co. VALID 10•7.1.•4q TO j- 1- to DRIVEWAYS: <br /> STREET <br /> P.O. Box 930 AREA ilo 6ky►t1k QUAD Ug ' <br /> Stockton, CA 95201 TYPE ttoLA-s-,(2) ' <br /> FORMSS-,���.Sfi <br /> NOTES <br /> L2D9) 941.2 - /y9v <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. , California supplement. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the A/4)2z-// side of �C- mEtZSo.cty/2 approximately <v ,o � -2loo feeY44 Lvt_sT- <br /> of 1-140 y 99 wLGVIL[i by performing the following work(description of work): <br /> 'EX if L", TE f 2�� <br /> .IhJ_S7,k1 L L s-y L,iq LtJff. <br /> Work will commence on or about 2 b - CST-09 for approximately 3 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 /> Signature of Applicant/-Title Date <br /> E1PUB.SV.WKIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01/08) <br />