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i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB#- 7.30, REF# <br /> Department of Public Works APN CR# <br /> EXP, DATE I <br /> VALID 12 // TO Ir/ /z DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET 'e'5 me— <br /> P.O. BOX 930 AREA QUAD ' <br /> Stockton, CA 95201 TYPE <br /> FORMS �y.►cl, 29 <br /> " NOTES —�—� <br /> 0q r'12 - /V'5 <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 3o36B X01 current M.U.T.C.D. <br /> Notif. 1v,5Sy0,46J ) 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 BAST side of 2)2 A*it'E' ALAS approximately 94 feet{rwiie jyu rll <br /> of Fo��Zi/r� Si. S;—DCX J1J by performing the following work(description of work): <br /> 19LA1/, CcrT AFF <br /> Work will commence on or about /2- b6c- B/ for approximately Bio 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 Date <br /> EIPUB-SV.WKNAASTER.PSIENCROACHMENTPERMff APPLICATION.DOC (01108) <br />