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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date AL,xg V 1 T �, 2 0 // <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# f 3 —� REF# <br /> Deoartment of Puhiir.wnrkc APN _ _ CR# <br /> Ili, , lll „i„IIIII,I, i EXR DATE y <br /> VALID 7 DRIVEWAYS: <br /> PG&E-FRESNO RMC STREET * <br /> DMD DEPT <br /> f. AREA ltd <br /> RIVERPARK PL EAST <br /> FRESNO, CA 93720 TYPE <br /> 1=ORMS <br /> NOTES <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted} <br /> I Traffic Control PlanSee attached l <br /> PM 3c9 33 sketch. Shall be as per <br /> ° current M_U.T.C.D. <br /> Notif. /c)s/g 9Z 90 California supplement. <br /> I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the EAST side of C/yES NU— <br /> , S./. approximately aO' <br /> of <br /> feedmile 50L44 <br /> 7— s Q /�, , o '- by performing the following work(descri tion of work): <br /> I <br /> Work will commerce on or about 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 described above in accordance with the rotes and regulations of San Joaquin County and subject to inspection and approval,. <br /> Signature of Applicant- Date <br /> �� Title- <br /> VIZ) _ U W L/C <br /> EiPI$SV.V/KNASIERDSENCRO,t�AeQ,Rp�gippp��,`��� - <br /> i <br /> i <br /> t <br />