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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: ' <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# �?066,P.-(o REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID t TO ! DRIVEWAYS: <br /> Pacific Gas and Electric Co. STREET "ter s,'/,�A)7 , ,ev , <br /> P.O. Box 930 AREA 37Mck7` Ad QUAD A4 " <br /> TYPE —SE e- <br /> Stockton, CA 95201 FORMS 2 <br /> NOTES <br /> (20q ) 91Y2 - l v9 f3 <br /> (Aria Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> See attached sketch. ; ; Shall be as per <br /> PM 3109989�f3 current M.U.T.C.D. <br /> Notif. /v5SySB2q California supplement. i <br /> The undersigned hereby-applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the LJ,5ST side of /iW Y' 99 452 AJTA-GE ,-L approximately 325 feeVm* SOU771 <br /> of LJ/4 L L E2. /Z L , S Tn eKr,0AJ by performing the following work(description of work): <br /> EX G/-t U,-4 7-z " /-IUB 0uZ51Z /'Y1�4/til /�cll� CGIY ��ic S�2lJlGE. <br /> /o/Yr M. I-IZJY 99 <br /> Work will commence on or about 12- 12-11 for approximately `ICJ 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 /> � t,57( Signature of Applicant-Title Date <br /> FiPU&SV.WKIMASTER.PSIENCROACNMENr POW APPUCATIOKDOC (07108) <br />