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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 24-0,6 OFFICE USE ONLY <br /> To : San Joaquin County I JOB # 73o6 6 REF <br /> Department of ]?ublic Works APN CR # <br /> EXP. DATE / �o <br /> Med'em zits 0 "rL'scrac LSO. VALID O / DpRIVEWAYS <br /> (Applicant Name) STREET <br /> /,, <br /> AREA l QUAD /t!E <br /> 4e2*b � LASr A TYPE A Q <br /> (Mailing Address) FORMS - <br /> NOTE <br /> (CityStat Zip Code) <br /> ry <br /> 2011 9ql - 079 - Nick -MaQtoo <br /> ( ea Code - Telephone Number) ..� <br /> Sketch (Detailed plans may be submitted) cu! *Y4 <br /> ` 0 <br /> CO va IS6 <br /> 2r10-'11*%A7'SE6ME0e SNodtAICQ AAO4k A PI7,5+,ry1i14r_ 4!r <br /> E.USu.� 7b -fAirt7779�R/ SJ�/9G�N�y �•/Q a�/� 14�vAJt�CE �t6.�v�4C A� LGA I�llol� <br /> ,444.x, <br /> U <br /> /fr 7-Ae /+ttl�iG'SECZ"l���VS ��TiQi51C7G<o �VX/1G !/5C 11Ti�-8 D�°+9rta cJ�' GDdTT}�AGI"1S�/ <br /> PN 30y707eA6 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on. County Highway Right-of-Way on the Lig sT side of <br /> LOW69 . 19A!r214PM5arro act Aeat 9 ..rVHVIAlr k . (64S r) TO JrNRIIAX <br /> Rb. (wESr) A"o _rifidA eo.(wicsr) Alex'"Alo by performing the <br /> following work (description of work): <br /> '1 SrALJ_ ; As b1,sr. R Lra4J4ro2 s rwr1,0A1 AA.16 4A.S &I.4/.✓ ay 0A0A1 <br /> Work will commence on or about .Zy �db for approximately <br /> 90 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 /> nature ofGrp'_ t caa - Title Date <br /> PIASTER.PS`,FEESL cera, RETURN PERMITS TO: <br /> PG&E <br /> JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br /> STOCKTON, CA 95204 <br />