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APPLICATION FOR ENCROACfi7`'IENT PERMIT <br /> PLEASE PRINT: <br /> Date �/ 1 � OFFICE USE ONLY <br /> To: San. Joaquin County <br /> JOB # 73052--4, REF <br /> De tment of Pu:blic Works <br /> fipN CR rt <br /> EXP. DAT <br /> VALID S Z/ TO / DRIVEWAYS: <br /> Appli nt Name) <br /> STREETG � -� Z31� <br /> AREA r'Tir.'✓ QUAD 05' <br /> TYPE �lT6LE DA95ff <br /> (Lra' ing Address) FORMS ?.�� ��L9 <br /> IInn NOTE <br /> / 1 <br /> * (City' St "te' Zip de) <br /> (Zo. Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C. o t' <br /> CALIFORNIA SUPPKMIN <br /> col q 7-7 z;'118 <br /> The undersigned hereby- applies for permission to excavate, const r t an <br /> of erwJse beroach side of <br /> o aCounty Highway Right-of-Way on the feet/� , <br /> a proximatel <br /> _ by erf ing th <br /> of <br /> of e-, <br /> fo l.owin wo _ (description of work) : <br /> for approximately <br /> War will commence on or about <br /> 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 nd approva)1: <br /> Date <br /> Signat _ G' AYpI"icar�t: - T1tle N PERMITS TO: <br /> �� <br /> PG&E - <br /> MASTEE.PS".FEESC'-MI. (6/00) JOB PROCESSM DESK_ BLD 1 <br /> (��O ^- <br /> V T CKTON, VA <br />