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PLEASE APPLICATION FOR ENCROACHMENT PERMIT <br />Date _ ?-2-? <br />— -- <br />-OFFICE <br />USE ONLY <br />To: San Joaquin County <br />JOB # <br />730052 REF # <br />Department of Public Works <br />CR # <br />APN <br />PGE <br />EXP. DATE DRIVEWAYS: <br />(Applicant Name) <br />VALID <br />STREET <br />6/10/2023 TO 12/10/2021 <br />Mary Ann \niay <br />3136 Boeing Way <br />AREA <br />I or�fnrcl QUAD NE <br />TYPE <br />Traffic Control <br />(Mailing Address) <br />FORMS <br />SSAnnni <br />Stockton Ca, 95206 <br />NOTES <br />(City, State, Tip Code) <br />(408) 316-1767 <br />(Area Code - Telephone Number) <br />STDIvPGEPerrnits@p9 e.com <br />(E-mail Address) <br />Sketch (Detailed plans may be submitted) <br />v <br />f <br />'1 1 <br />I � <br />� <br />I I <br />xlc -7 14y,,/"�7 <br />/L� /1 <br />ti <br />S' <br />The undenjigned hereby applies for permission to <br />excllvalte, construct and/or otherwise encroach on County hi way right -of- yon <br />Ve <br />the side of �,c� !fir <br />GcJ. , <br />approximately � ® fee mile <br />of Slew_ ✓ 1 <br />L� kA ' <br />� . by performing the following work (description of work): <br />�� JULY.✓ Crr�/oSei <br />im <br />pe-Pe� <br />Work will commence on or after / b - 7- 3 <br />for approximately 180 days_ <br />I, the undersigned, certify that I am the ow <br />respective property, or am qualified to represent the owner and agree to do the <br />work described above inaocorda I the rules <br />d regulations of San Joaquin County and subject to inspection and approval. <br />7-2,3 <br />S of plicant - Title <br />Date <br />