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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73605Z-6- REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE x.15. 911>/0 <br /> Pacific Gas and Electric Co. VALID % Z,.,/d TO 2cjo DRIVEWAYS: <br /> STREET 5?;*41gg , <br /> P.O. Box 930 AREAQUAD 9,5 <br /> ` <br /> Stockton, CA 95201 TYPE � 1---�lna4 — <br /> FORMS !FV / z9 <br /> NOTES <br /> 2 V2-/1/ 0 <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 30?NSvS2 current M.U.T.C.D. <br /> Notif. lo y/l.1,925 California supplement. <br /> I/'/.S <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EI4S J" side of S. cb,*1Wz S 190,4- approximately 22 y feed;;+ie Sourlt? <br /> Of [Jr4S1.11NbTQA1 .9T- by performing the following work(description of work): <br /> �f'C.t/ T fZEit/Cf� TiS�iPOULN �TG/f Tb ZAIS774L4 A/Fi.) 6A-,G <br /> I�EPL�Gr EX/ST/�JL SQ /GE r_'Y ,QT'S C-XPQS4rQ SAJ GQZ_O'A./TS' ZRJILAb%5-' L/Md <br /> Work will commence on or about - /7 KIL - `ID for approximately 4.11010 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 Joaqumin County and subject to inspection and approval. <br /> az Z;Jqs /2-29-v,7 <br /> Signature of Applicant-Title E Sri1'17M-012 Date <br /> E:1PUB&SV.WKIMASTEPPSENCROACHMENTPERMITAPPLICATION.DOC (0110M <br />