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PLF, ,SE PRINT: APPL6MON FOR.EiNCROACHMPERMIT <br /> PER <br /> Date December 7, 1995OFFICE USE ONLY <br /> JOB # ..7 3 ZS7 9 <br /> RE <br /> F# <br /> To: San Joaquin CountyIHighwa AFN CRV <br /> Y Department. EXP. DATEV�11Pacific Bell V -ID RIVEWAYS: <br /> (Applicant Name) STREETSAREAD ' <br /> - 44 W. Yokuts Avenue TYPE <br /> FORMS <br /> (Mailing Address) NOTE <br /> Stockton, CA. 95207 <br /> (City, State Zip Code) <br /> 209/474-4235 or 474-4723 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> SEE ATTACHED DRAWINGS <br /> When billing please refer- to Pacific Bell Job #UE1842R. <br /> Report code - 4C - 750 :& 812C - 250 <br /> UE76 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> Briglway Ri ght"of"-Wa County <br /> y�e,at <br /> various locations as shown on the a�k/ <br /> work: (description of work ng j:attached hket <br /> followiimatel 31 <br /> by Performing the <br /> 30" 55 feet in as halt - remainder in dirt, Place .l2barrelovaultduit and 1-3min. <br /> x coverage <br /> b o v - bo h #rJ d,Rt '�Spllc <br /> T <br /> Work will commence on or about 19 9 r- <br /> s;. �"a NKa RN s, for approximatelydays.J8 o <br /> ..` <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the work described above in accordance with the rules,regulations of San Joaquin County and subjec <br /> to and ap rov tY t <br /> SIOF ICAINIT - TITLE <br /> DATE <br />