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APPLICATION FOR ENCROACHMENT PERNT <br />PLEASE PW: <br />r! <br />Lz - q q 7 ;, <br />To: Sal Joew County <br />Deper6nent of Pubic Works <br />Paafic Gas & EWcUx <br />(Appli Name) <br />3136 Boeing Way. Sbctdon <br />(MmTffq Address) <br />SbUmn Ca, 95204 <br />(may. Sbite, Zip Code) <br />406-31611767 <br />(Area Code - Telephone Number) — <br />STDIVPERMiTS@pge com <br />(Email Address) <br />Joe <br />APN <br />730052 <br />OFFU USE ONLY <br />REF 1T <br />Cit 4 <br />EXP DATE <br />V&V <br />STREET <br />stvzgza <br />Armstrong Rd. <br />TO lvvzgza DRNEWKfS: <br />AREA <br />TYPE <br />Aerial Work <br />ot1AD <br />F'OFW <br />NOTES <br />ssM <br />Special Conditions <br />Sketch (Detailed plans may be submitted) <br />.� 9- C� <br />The undersigned hereby applies for pernassiort to excavate, construct and/or otherwise encroach on County Highw Flight -of-" on <br />the side of r S approximately 1 •i if ile s— <br />of h r r: I L rr/ by performing the following work (description of work): <br />��� •r��c r Nlbl-; !' <br />Work will commence on or after L ` for approximately leo days <br />I, the undersigned, certify that I an 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 />Signattir otApplicmd- rde Date <br />