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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date /0-/-';� - Q q OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73 -(n REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE 3 - 1- 10 <br /> Pacific Gas and Electric Co. VALID TO D DRIVEWAYS: <br /> STREET j- <br /> P.O. Box 930 AREA QUAD L!O ` <br /> Stockton, CA 95201 TYPE <br /> FORMS <br /> NOTES <br /> (Afea 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 nG 7L,i�,6 5 current M.U.T.C.D. <br /> Notif. /033 1533 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 LJCST side of P approximately 64,D° 7D7-AIL feet/ffli4, Al. r4mtk S. <br /> of L R/LiC- Z LJY SrQC1<r0A,1 by performing the following work(description of work): <br /> REPLACE C I-M-U& 614.E FAC1L/7745S �' y 1 klelz"/r -N /L1 QR,!E/J <br /> T2C.VCi-11AvZ, <br /> Work will commence on or about /L -A/ov-Del for approximately 910 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 /> 004, ff <br /> SRrS D`7 <br /> Signature of Applicant-Title S7-147,172012 Date <br /> E:IPU&SV.WMMASTERPSIENCROACMMEWTPERMITAPPLICATION.DOC (01/08) <br />