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Oct, 14. 2011 12: 25PM Pacific Gas and electric Co, No. 0033 P. 2 <br /> -301 b(0$(05 APPLICATION FOR ENCROACHMENT PERMIT � <br /> f <br /> PLEASE PRINT: <br /> Date j t OFFICE USE ONLY <br /> To; SanJoaqulnCounty JOB# ��CY>`"oZ-� REF# <br /> Department of Pubho Works APN CR# <br /> EXP.DATE Z r <br /> . ., VALID i.01R17!► Iz i t DRIVEWAYS <br /> (Applicant Name) STREET roa <br /> AREAQUAD 55 <br /> Cdt t a�41f t�.� TYPE o w�cmc <br /> (Malling'Address) FORMS <br /> NOTES <br /> (Cltyr State,ZIP Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Dotalled plans May be subin(((ed) <br /> The under3lgn6d hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right of-Way on <br /> the G side of Pk-1 approximately _(gam ` eemile S _ <br /> of Iminm iNu 1�11� _ ,by performing tha following work(description of work): <br /> Work wilt commence on or about ti 4 far approximately days.. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualllled'to represent Ilie owner and agree to do the <br /> work described above In accordance with the rulas and regulations of San Joaquin County and subject td Inspection and approval, <br /> ` ignature of Applicant-Titre Det <br /> E�,esv.w'M1wtir�xFr�+cwo�m+rdrrve?aracr�iux w�� <br /> i; <br /> fi <br /> i <br />