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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE 2, <br /> c>, t i �.r„ -• f ;.i,-r ;t'r'r c. VALID 12 t T /S Q. DRIVEWAYS: <br /> �TREET _' /�itt�.� 4). <br /> PG&E-FRESNO RMC RPE QUAD /1/GlJ <br /> DMD DEPT �� <br /> 8 RIVERPARK PL EAST ORMS <br /> FRESNO, CA 93720 TOTES <br /> (City,State, Zip Code) <br /> (Area Code Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> , 7 <br /> ralm- �rlaea � Q���r �yy ���, mss. ,� <br /> 1 <br /> / 5 � <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the 6A; sideof �i,d��'1`, . i< <.,�; , <br /> Of IA40-k z ;IN= approximately �t� c=X= feet/mile <br /> �'` ' '`'"�'� �"�'� by performing the following work(description of work): <br /> ry <br /> 1.01 ! <br /> Work will commence on or about ':�X i for approximately C--,-"' days. <br /> f,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 /> Signature of Applicant-Title Date <br /> E?PUBSV.WKUAASTER.PSIENCROACNMENT PERMIT APPLICATION.DOC (01108) <br />