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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: / <br /> Date --- �' �L�--- OFFICE USE ONLY <br /> To: San Joarniin County JC,2 1i REF 4 <br /> De artment of Public Works A.PN CR <br /> EXP. DATE- 0 <br /> VALID Z 13 TO DRrVEWAYS: <br /> STREET au sal Jy <br /> n, AA,& <br /> (Applicant Name) � i <br /> AREA STX11/ QED <br /> TYPE(2)?h&L 10(.ES t TRE�Ci�t <br /> (Y-ailing Address) FORMS 05(W&01 �9 <br /> NOTE <br /> City, State, LP Co e) -- - I <br /> 5 _ <br /> {Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted.) <br /> �ri < 0o3 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encro c on County Highway Right-of-Way on the �cu__�4 _ si e of <br /> IJ 141 _, approximately feet <br /> of by p rform t e <br /> f..ollow ng �w,ork .. descr.iption of wor ) a <br /> -� <br /> Work will commence on or about for approximately <br /> days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> — --_—_acr�r9ancP w;tL the rules regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> --7' --- <br /> -ate <br /> -.p, t tie <br /> Si-j--at-aze of n <br /> RETURN PERMITS TO: <br /> nrsTrea.ps,eeEsciro� <br /> PG&E <br /> JOB PROCESSING DESK -BLD 1 <br /> 4040 WEST LANE <br /> c-r-r'V- rd r.A 9 704 <br />