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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: j I j <br /> Date ! j OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7300$'.-r' REF# <br /> Department of Public Works APN — CR# <br /> I-IF mEXP.DATE S i5-ii <br /> PG&E VALID '4 0 S rr DRIVEWAYS: <br /> (Applicant Name) STREET Go wEr� ,qv� <br /> REA ST21`--1CMif/ QUAD W$ <br /> 8 River Park Place East OPE t-yaLE IZEPtRt_E F.�- _ <br /> ORMS <br /> Fresno. CA 93720 OTES <br /> (City,State,Zip Code) <br /> 1 <br /> km ea 1-6ae- i elephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> r <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highaaay Right-of-Way n <br /> the 9„� � side of _c ; 1 r'�t l approximately I ;' ' <br /> of -Je.— Pp y (feet/mile ie <br /> by performing the following work( scription of work): <br /> Please refer to construction drawin s for work locations. <br /> Work will commence on or about ' 2-S r for approximately <br /> days. <br /> I, the undersigned,certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work deed above,i ordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title <br /> U e <br /> l-e <br /> E'.d”J9-SV.WI(1MASiER,PS;ENu?OAC-MEN7PERMILAPPLICATION.DOC <br />