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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT <br /> OFFICE-'t LSE ONT-,Y <br /> Date O v (Q <br /> jB iL 2-& RE <br /> To: San. Joaquin County CR <br /> De. rtment of Public Works <br /> ApN <br /> EXP DA�T�jE�p(p 9 /S <br /> VAJ IR a'*`� O 19J( DRIVEW?YS <br /> (Applicant Name) STREE`IItY <br /> AREA ..5`'7_iW , QVAD *. <br /> /� <br /> wt/IJ+ L�� TYPE <br /> (Mailing Address) FORMS � . <br /> NOTE <br /> ty, state, .Zig Code) <br /> (Area Code .-Code .- Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> v _ <br /> 4/0- <br /> d7 35 <br /> The undersigned hereby a9.pplies for permission to excavate, con t Ct and/or <br /> side of <br /> Co <br /> otherwise encr ach o unty Highway Right-of-Way on the feet/fie <br /> a/ approximatel <br /> )D -- ✓?. by er.f ing the <br /> o.f . <br /> f�llowi g wp k (description of York) <br /> L v �. <br /> E for approximately <br /> Work will commence on or about <br /> days' <br /> 1, the undersigned certify that i am the owner of the- respective property, or am <br /> qualified to represent the ownerand 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 /> . . �� <br /> Date <br /> L T-.�-1 - T1t <br /> si yua�ure r,- r_rr _cant RETURN PERMITS TO: <br /> MASTEE.PS\EEESC-IDL (6/00) PG&E-*B PROCESSING SK-QW <br /> 1 <br /> _4040 <br /> STOCKTON. C/►952N <br />