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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date JO- 13- o q JOB# OFFICE USE ONLY <br /> 7 G�$2-� REF# <br /> To: San Joaquin County RE# <br /> Department of Public Works APN <br /> EXP.DATE i2- I.Ol <br /> VALID TO iZ-1.09 DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET ! Ary&nA✓E Arra <br /> AREA QUAD AW <br /> P.O. BOX 930 <br /> TYPE D <br /> Stockton, CA 95201 FORMS <br /> NOTES <br /> —7(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 3 3, 32 <br /> current M.U.T.C.D. <br /> Notif. 1 v Yr'1`'2 -7(e California supplement. <br /> 2,6-� ,tE 4777s9,-- I-�1� ..SJCETCI- <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the A,10,2T/-ll side of !--242 . z.'7- 6ROLAE Rb - approximately .27z feeUmleLJ EST <br /> of i{o/2 v)-'o/,/ 12D- , e%l0A!1V 7 )A.1 by performing the following work(description of work): <br /> L-Jkq 7`.C. 122 44 Z-10-4,fiu . •2T W12 <br /> l�vuS -.S 77-) .3E <br /> 902 S' L'-.)A4-A a)- G2vuE QD. <br /> Work will commence on or about I2 -Ala 09 for approximately 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 /> 2 -09 - <br /> Signature of Applicant/-Title Date <br /> "pu",V...,TER.PSWNCRDACHMEMPERMITAPPl1CATION.DOC (01108 <br />