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i <br /> i <br /> i <br /> i <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date '� r <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# �; - REF# <br /> APN <br /> I EXP.DATE CR#Z6d <br /> VALID d G'O Z 0 > di DRIVEWAYS: <br /> STREET <br /> PG&E-FRESNO RMC AREAz� (QUAD � <br /> DMD DEPT TYPE <br /> 8 FPIVERPARK PL EAST FORMS - <br /> FRESNO. CA 93720 NOTES <br /> �fCity,Sta e,Zip Cade) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted} <br /> C <br /> i <br /> I <br /> The undersigned hereby applies for permissio to excavate,construct and/or otherwi <br /> the side of se encroach on ounfy Highway Right-of-Way <br /> �"�� <br /> of / �- approximately on , <br /> Ac3S --;Y TSG- ,by performing the following work(description of <br /> /td yam. ,ice <br /> •4�a�rp E"P <br /> Work wilt <br /> commence on or about <br /> -- --_-- for approximately i1j E�'`� <br /> I,the undersigned;certify that I am the owner of the respective property,or am qualified to represent the owner and agree too days. <br /> work desc' bove in accordancwith the rules and regulations of San Joaquin County and subject to inspection and a <br /> 9 do the <br /> pproval. <br /> Si urr o plicant_T U e- <br /> fid�r3tr�// <br /> EVHa-SV.VMVMAST 1CROACIINEIir PER&UAPPLICATfOR.000(0tMS) Da <br />