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APPLICATION FOR ENCROAC=1ENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin <br /> County .JOB TF � 2 REF # <br /> Department of Public Works <br /> AIN <br /> CR rt <br /> TE <br /> {./ VALID �� (�rn TO DRIVEWAYS: <br /> (App li c ant Name) STREET �l rUIr1E� /f�l'K• <br /> T--REA :5rry-i/• __ .QUAD FS <br /> TYPE...SLG f�OLF <br /> (Marling Address) FORMS L9 <br /> NOTE <br /> {City, Stat Zip code) l <br /> r <br /> ( a Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> LID <br /> The undersigned hereby applies for permission to excavate, c nst ct and/or <br /> Hi hway Right-of-way on the side of <br /> otherwis nc t� g @on <br /> n,, approximatel _ feet/ <br /> by p rfo ir4q the <br /> of <br /> fo lowing work .Cd�script�cn of work <br /> ..rte <br /> for approximately <br /> Work will commence on or about <br /> dans <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 nd appro-vaT --- - - <br /> Data <br /> �+ T y tl <br /> J1y1161.V.rC of ��_Ji 1i1..6ut <br /> RETURN PERMITS TO: <br /> A.STE?.PS\FEES=L (e/001 PG&E <br /> JOB PROCESSING DESK -BLD 9 <br /> 4040 WEST LANE \ <br /> --rerrv-rr)N1 r to 95204 <br />