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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date -7 ZAI� ( OFFICE USE ONLY <br /> To: San Joaquin County JOB REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE p�,� <br /> VALID r! 0 G is i DRIVEWAYS: <br /> STREET low <br /> IIIuIIIiIIII �Ii �� AREA /0y/ QUAD <br /> PG&E-FRESNO RMC TYPE f iul ' <br /> DMD DEPT FORMS S5 �.✓w, —a-2"7 <br /> 8 RIVERPARK PL EAST <br /> FRESNO, CA 93720 NOTES <br /> (City,'State,Zip Code) <br /> (Area Code-Telephop�C'ne 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 a of ZA _ _approximately y,4/cR$ ' feet/mile <br /> of RZA, by performing the following work(description of wo <br /> c5'04she cAj <br /> Work will commence on or about (4 / // for approximately days. <br /> 1,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 rules and regulations of San Joaquin County and subject to inspection and approval. <br /> rgnatu of Applicant-Title D6te <br /> EIPUMV. TERPS%MCROACHMENTPERMrrAPPUCATIORt)OC(DUOS) <br />