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ADPL .CATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date — O5� v OFFICE 75E ONLY <br /> To: San Joaquin County JOB #?��pSZ-(D REF #_ <br /> e rtment f Public Works P-PN CR' # <br /> �� � EXP. DATE �- <br /> �1l VALID TO S DRIVEWAYS: <br /> �c (Appliclant Name) STREET <br /> ,AREA 'S7dGlf7V4 QUAD <br /> (f ! TYPE 1-.,E lL h'61 F <br /> (Mailing Address) FORMS (�LU. 1Z-Z9 <br /> NOTE _ <br /> *(City, tate, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, constru t and/or <br /> oth .rwi�e en roach OP County Highway Right-of-Way o the si e of <br /> o(42-r4'9 �_ approximat feet/,a= <br /> of A n *1 <br /> , by pero g he <br /> f llowin work (description of work): BIPW <br /> Wo will will commence on or about for approximately <br /> J 0-22 __ 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 /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection an approval. <br /> S-'q--at-,=e oZ Arpl--carat - Tit—la Date <br /> "LkSTERPS. ,FEESCML !Glao, RETURN PERMITS TO: <br /> PG&E <br /> JOB PROCESSING DESK —BLD 1 <br /> 4040 WEST LANE <br /> CTnr'VTnni r p grqnd <br />