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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# 6'�('- REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP.DATE -447,,t, <br /> 4:_ VALID TO DRIVEWAYS: <br /> STREET <br /> 05 <br /> PG&E AREA QUAD (X <br /> ORMS <br /> 8 River Park Place E S <br /> Fresno., CA 93720 NOTES <br /> (City, State,Zip Code) <br /> (Area Code m Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the j side of L A ,e <br /> approximately feet/ri .- Sr,,11, <br /> of <br /> < by performing the following work(descrtpTion of work): <br /> /I <br /> Work will commence on or about <br /> for approximately days. <br /> 1,the undersigned, certify that I am the owner ofThe respective property,br am qualified to represent the owner and agree to do the <br /> work described above I in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> rr <br /> g. c pp I ant-Title Date <br /> W <br /> E ftB-SV WKWAST PSIENCROACHMEW PERMIT APPLICATION DOC (01/08) <br />