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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /0 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE t•lt� <br /> Pacific Gas and Electric Co. VALID q.z--oq TO t•i. ,o DRIVEWAYS: <br /> STREET ! Q v <br /> P.O. BOX 930 AREA d /u.� QUAD Alj5 _ <br /> Stockton, CA 95201 TYPE <br /> FORMS �c1xa. JL5 <br /> NOTES d <br /> �y98 <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 /> PIA `l f 1 .25a's current M.U.T.C.D. <br /> Notif. /03 13 12- 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 .E01,1 1� side of i_^.�L 11ny[ZAjA 12L approximately SSD feet/40e <br /> °f ''�� " I ' CULL IL 2 L11z_ by performing the following work(description of work): <br /> d34'Z-L. X1Q L4E_ /JL-h fZ 723 <br /> � tJf4LL1Lc., <br /> Work will commence on or about 2G -oG1"-09 for approximately 3/ -o`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 /> R i4 E�T7VYI -Toff <br /> Signature of Applicant-Title Date <br /> E-'WS-SV.WMMpSTEP PSIENCROACHMENT PERW APPUCATICKDOC (07108) <br />