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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 12 - 27 OFFICE USE ONLY <br /> JOB# r�r�5� # <br /> To: San Joaquin County REFCR# <br /> Department of Public Works APN <br /> EXP.DATE <br /> VALID TO i-IS'- DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET - -a-� <br /> P.O. Box 930 <br /> AREA `� tffr>rt QUAD <br /> Stockton, CA 95201 TYPE Z 6 :U <br /> FORMS ` <br /> NOTES <br /> (tog ) 4K2- 1A19 <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 A-( t 1JH 3163 current M.U.T.C.D. <br /> Notif. toslbo�-{to <br /> 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 S Tt-f side of_ 5AC6 a ST approximately 75 feetla+e EAST <br /> of M I-, cotin a ravE= - sl'oct{T-o iJ by performing the following work(description of work): <br /> F-X e-/q LJ/q T*4S ( ,R461-4- Hoc-ES XPJ 64SPNALT <br /> Work will commence on or about_ l2- ZK-to for approximately CorvnC'C&� --deY-- <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 /> _J4 �� ��� 1 Z-- Zq-/0 _ <br /> Signature of Applicant-Title G-ST-1 M 7-012 Date <br /> 1 <br /> EIPU5-SV.WK1MASTEP PSIENCROACHMEM PERMIT APPUCATION DOC. (01108 <br />