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V <br /> APPLICATION FOR ENCROACHMENTrr PmERAEACEIVED OUIN N <br /> PLEASE PRINT: / 206 JUL 14 AM 10: 42 <br /> Date L� �/ agPI'?'M MO ORKS- <br /> To.- San Joaquin County JOB # ! X2-10 KF,r <br /> Depa Ment of Public Works A-PN CR: # <br /> EXP_ DATE <br /> VALIDL V <br /> TO fZ-/�O<o DRIEWAYS: <br /> (Applica t Name) STREET- <br /> v V AREA 25?;YzZ QUAD ZW <br /> j TYPE 'BUd.1- t'f,O,GE A' 'Ti 44-0r-� <br /> (Mailing Address) FORMS �c' `!1, eey <br /> NOTE <br /> City, Stati, Zip Code) ' <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> 3dS1 c)1 <br /> `7 <br /> �G DIS 0 <br /> l �5S <br /> The undersigned hereby applies for permission to excavate, c struc - and/or <br /> otherwise encroach on Co;unt Highway Right-of-Wa on theside of <br /> I.�i�(]_- approximatel feet/== <br /> of u.e, b erform nq the <br /> fo110 in;-fork (descripti njofork <br /> c <br /> Work will commence on or about for approximately <br /> 20 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, regulation of San Joaquin County and subject to <br /> inspection and approval . <br /> 4z Z- 4 4-e 014 <br /> Sigr�atu�e of Applicant - Tit" Da <br /> PG&E <br /> MASTER.PS\FEESG'IDL (6/00) DESK BW 1 <br /> MMO U <br /> Q�M ~ <br /> V T OOMN, CA <br />