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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> 9�// OFFICE USE ONLY <br /> y � _ <br /> To: San Joaquin County <br /> JOB �3o5Z (p KM,F <br /> Department of Public Works <br /> �pN CR <br /> EXP_ DATE <br /> PgciFic C�• VALID J-1 y-'9C- TO /01/9-696 DRIVEWAYS <br /> (Applicant Name) STREET MAY AL <br /> I;- <br /> Tb c tiS QUAD E <br /> y0 ND !..)ES/ L.gAJ, . TYPE t.t. HOLE EowE <br /> (Mai.-i4__ Address) FORMS — <br /> NOTE <br /> sraefKMAI era 9sza� <br /> (City, State, Zip Code) <br /> 9y2 -/S3S <br /> (Area Code - Telephone N=ber) <br /> Sketch (Detailed plas may be submitted) TRAFFIC CONTROL PLAN <br /> n <br /> SHALL BE AS PER <br /> SEE /9TI",�L/�E/� SKET'G✓�/ CURRENT M.U.T.C.D. <br /> cn CALIFORNIA SUPPLEMENT <br /> eta c�c <br /> 0 <br /> LU. <br /> Cn M <br /> Lu <br /> or C w <br /> Pln 3052-1737 <br /> C= }A- <br /> " Th��signed hereby applies for permission to excavate, construct and/or <br /> Lr side Of <br /> otherwi�e encroach on County Highway Right-of-Way On the feet/ e ��2T�--- <br /> /9L/�t, approximately Zl7 <br /> S by Performing the <br /> following work (description of work) : <br /> GC�f¢l//9TE L ELL 6604E O[JE./L LAS /YIf9/.c! 4414 aDRE ST.eEET <br /> Ty ZAa7/4G.L IV <br /> for approximately <br /> Work will commence on or about <br /> -1[7 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 and approval: <br /> IA-1 AuAteL�� :ata <br /> s= - �a Appl�ica:t - Title RAN PERMITS TO: <br /> PG&E <br /> N.rSTER.PS',rEESC-mL !F/C�) -s,� PROCESSING [*SK-BW I <br /> VKV�i�I <br /> STCKXrON, CA 952" <br />