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APPLICATION FOR .ENCROACEMENT PERMIT <br /> PLEASE PRINT: <br /> Date /'[�i rC�L( U OFFICE USE ONLY o <br /> To: San Joaquin County JOB #.17%j ,-(1J REF #c ,.�, <br /> Department of Public Works APNCg... # <br /> }3 ' <br /> EXP. DAT <br /> VALID 3 20 <br /> (Applicant Name) STREET <br /> AREA :5ne,&Mwl QUAD <br /> We'd /—/—.C,.,E-. TYPE l9 116,ellr _ � <br /> (Nailing Address) FORMS <br /> NOTE 7 <br /> _0Y <br /> (city, State, Zip Code) <br /> - 2vS : 9yz - ���s <br /> (Area Code - Telephone. Number) <br /> Sketch (Detailed plans may be submitted). <br /> .lei <br /> TW 50487/42 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encr$$ach o County Highway Right-of-Way on-the Ens f- side -of <br /> RtO�Wo /4•/�. approxi.mate y oU feet./rtt14 /V�r-74A <br /> Of �i / ff Ve by Performing the <br /> following work (description of work) _ <br /> old ' br <br /> Work,will commence on or about T -2-00 r for approximately. <br /> Q days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and- agree to do the work described above in ' <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant - Title Date <br /> �+srsa.rs� sr�a ce�.oa� RETURN PERMITS TO: <br /> PG&E <br /> JOB PROCESSING DESK, BLD I <br /> 4040 West Lane <br /> 7 Stockton, CA 9521011f <br />