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n n ^iqe n n <br /> L L'✓ tl! P3CI c Gas i C f- t <br /> APPLICATION FOR ENCROACHLVV INT PERMIT <br /> PLEASE PRINT- <br /> I <br /> Date 4.27-lo <br /> To: San Joaquin County-Highway Department 4' <br /> OFFICE USE ONLY <br /> JOB# 30761978 REF# <br /> PG&E APN_249 - 070 -_12 CRV# <br /> (Applicant.Name) EXP.DATE <br /> 1524 Irl. CARPENTER RD- <br /> (Mailing <br /> to TO ! d & DRIVEWAYS: <br /> (Mailing Address) STREET �jg f) <br /> AREA la,4 QUAD <br /> MODESTO,CA. 95351 TYPE . oGE 5 FORMS j <br /> (City, State,Zip Code) NOTE ' <br /> 209-576-6603 Q a, 7b-{oto 31 ser�;O) <br /> (Area Code-Telephone umber) <br /> Sketch (Detailed plans may be submitted) <br /> i <br /> C See <br /> t <br /> """"+7 <br /> �M1+7 �./V II <br /> I <br /> �•,,�,k-kre_e-n ,�4 P t...ai� 249 0-70 - 1 o J ! IJ 0- and <br /> Grpun 1 (s,+ A°N . <br /> n t� A Ggr/c.�-3-t rQ n t.r a a[ S J f -��► <br /> %,i/a �jl <br /> a-F ��) �erv!te.� C Q/� �5� awd IriS�.�����n a�- ( b�.•► rti5 k. G�5 Nti0.cn <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway Right-of-Way on the W side of Santa Fe Rd. approximately 800' <br /> feet/mile S of HM Rd. by performing the following work (description of work)- <br /> Excavate 355' of 1'trench and 3)4'x4'bellholes <br /> Work will commence on or about 5/17/10 for approximately 5 days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the <br /> owner agree to do the work described above in accordance with the rules, regulations of San Joaquin <br /> County and subject to inspection and approval. <br /> ���^ •�- �Z 7- 2,010 <br /> S A E PLICANT—TITLE DATE j <br /> i <br /> i <br /> I <br /> i <br /> 1 e4 L' <br /> i <br />