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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN Y CR# <br /> EXP. DATE - T <br /> Pacific Gas and Electric Co. VALID i7--V-0q TO 9• /0 DRIVEWAYS: <br /> STREET CRe'4Le&F-;2 E ' <br /> P.O. BOX 930 AREA 'S-rbcjC d QUAD � ` <br /> Stockton, CA 95201 TYPE E <br /> NOTES - <br /> 209- 9y2 -/y" <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 3 v-7385"5'0 current M.U.T.C.D. <br /> Notif. /Dydg7;x9lCalifornia supplement. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the iUD2J"N side of ewo!2 'EA112�r e /Zpapproximately 30 feet/wAe :�-L?s7- <br /> of 1210 STDG,Q.Jby performing the following work(description of work): <br /> ©2L14n,2 7-v Z'eco s Ts4L L- to - - - - /Vn/0 �T <br /> l3 �/L c�s Lo r�y 7'U E.�c c>y[/`y�`E' y9 3 '�c 3 '- r3 L:L-4. l-1101.45 6AJQ1 <br /> T/ZCAJ� /5 FT /4LL C.Jc��2K 2S Ty Bcr Z/V 22 /757 <br /> Work will commence on or about 2 for approximately 7 0 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 G.S71M,17-D/2 Date <br /> E:IPUB-SV.WKIMASTER.PSIENCROACHMENTPERMRAPPUCATION.DOC (07/0 <br />