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VAR 17 2)12 <br /> F'R1ESPJr� <br /> APPLICATION FOR ENCROACHMENT PERMIT NOTI08997899 102514265 <br /> DIVID/cf,J) <br /> PLEASE PRINT: <br /> Date 1/30/2012 <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# �3j�- �' REF# <br /> Department of Public Works APN <br /> CR# <br /> PG&E EXP.DATE <br /> (Applicant NVALID T DRIVEWAYS:ame) STREET ��yejN <br /> �C✓1' Pxa- Alli e& e� AREA t�,�1-on/ QUAD <br /> n (Mailing Address) TYPEFORMS <br /> I�1'�S�lJ� �Q•, (,�,��f�� NOTES <br /> (City,State, Zip Code) --- <br /> 916-760-5390 <br /> (Area Code Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED SKETCH - LOCATION 1 <br /> ArewTa S r3o 4-4,e <br /> m.e. <br /> AlinV,ow4 4- <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the SOUTH side of MICHIGAN AVE <br /> of N KIRK AVE approximately 600 FEET feet/mile EAST OF <br /> REPLACE POLE AS PART OF R�DUTINE MAINTENANCE performing <br /> the TIMIE ANTICIwork PATED TO BE <br /> NO MORE THAN 2 DAYS BUT CAN OCCUR INA 6 MONTH WINDOW FOR STARTING. <br /> Work will commence on or about FEB 2012 THRU AUG 2012 for approximately 2 DAYS <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 rules and regulations of San Joaquin County and subject to inspection and approval. <br /> /�cEae�GwwreCro air a�eKt�or Plj'&E <br /> Signature of Applicant-Title 1/30/2012 <br /> Date <br /> E1PUB-SV.WKIMASTER PSIEINCROACHMENT PERMIT APPLICA7 ION DOC(01,08) <br />