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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /U -/I/ - D 9 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73op5 2-e, REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 3. 15. 16 <br /> Pacific Gas and Electric Co. VALID fa.•''I•aao�2 TO 3'1�• DRIVEWAYS: <br /> STREET STAR- ST. <br /> P.O. Box 930 AREA 'Fk�Ae,C(l y QUAD _A&2 <br /> Stockton, CA 95201 TYPE 1NELL "d o <br /> FORMS <br /> NOTES <br /> <zog) 91-1a - P/9s <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 30sY4/Vi,�ov current M.U.T.C.D. <br /> Notif. /U 22 3 y72,09 California supplement. <br /> .SCS iq77Af:AXC-z.) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way <br /> XAJ 7WE 1'.t/T�.r2SE�T'/vsV ®oma �3�9etln/L2 ST. /9ti1d1 .�7�42 S1': <br /> by performing the following work(description of work): <br /> sfl2'c r TV -riVS 7-WL-L il/GGJ ZAs IYlso/AJ <br /> Work will commence on or about. 3F for approximately 9V 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 /> E.'IPU&SV.WKWMERP51E=ACHMENT PEW APPUCATIOILDOC (0110 <br />