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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /I- 29 -02 OFFICE USE ONLY <br /> To: San Joaquin County JOB# M:y52-4. REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE &./5•/d <br /> Pacific Gas and Electric Co. VALID TO 6-e<-AD DRIVEWAYS: <br /> STREET 9,q�,�ES /". <br /> P.O. Box 930 AREA QUAD Fs <br /> Stockton, CA 95201 TYPE 'SLG .yW�, f�✓e,?�.+�� <br /> FORMS <br /> NOTES <br /> 2013 - 9112- /V90 <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 3077(S0-/l current M.U.T.C.D. <br /> Notif. /0 yl-T,3y3 Z California supplement. <br /> 2Y9 S. L'AWz-5s AvE 4y <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the- 6-19,S7- -side of S. b,4&JzE-9 19aE, approximately 2BI/ feet/wAe S 'N <br /> Dur <br /> Of GJASifsAy,6rQAJ .9T. S'TD,CA12On1 .by performing the following work(description of work): <br /> LXCs9lJ/9TL- 13L-`LL /�vLE �uEl2 Gs9S /'YId9�.t1 aoeE s7i2EE7- I'JAAD <br /> yPr�y rReXlCl-I I-MMQ .uy/- Ll 17-e hl no --A-A1 S'T14LG ti/C7.3 Gds sZeulgel <br /> )e6P1-Aed5 E3017-11JZ, -SEtLl14f45 rjYAQT**S d XFt75d.iQ Xi11 CQ41AJ `/ DeA1AMZg5 1)/TC/V <br /> Work will commence on or about S- /aP211- - `10 for approximately &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 /> 12 -.28-02 <br /> Signature of Applicant-Title S7-1 pyon7-o12 Date <br /> E:1PU&SV.WKIMASTER.PSIENCROACHMENTPERMRAPPLICATION.DOC (01/08) <br />