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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 22 N - 201 � 2-C. '` OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73G}oS.2•iii REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 14—/$"--ZOl O <br /> Pacific Gas & Electric Cornpany, PG&E VALID 1-4-ZyL1 TO DRIVEWAYS: <br /> (Applicant Name) STREET I I A�t Q, Vekr 10 NS &fir s1r fiS <br /> AREA QUAD _ <br /> TYPE Re-—>,c*- <br /> (Mailing Address) FORMS S.Slig ) 2� <br /> yT-27;".- 7:,; c * c '� _, { NOTES <br /> 1 <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 5k=-= A'TT&CA i.?j <br /> Pc7y l 5-Y 7 <br /> LL <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of_ approximately feet/mile <br /> of by performing the following work(description of work): <br /> Please refer to construction drawings for work locations <br /> PG&E will be replacing the existing overhead conductors and from time to time replacing poles, a u*pment <br /> and r ac*ng/removing/install iIng down guys a��quired, <br /> Work will commence on or about 3 for approximately 7C 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-Ve Date <br /> EIPU&SV NMIMASTER PSOICROACHMENT PERMIT APPLICATION.DOC (O"BIOS) <br />