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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date I/ /OIL aL OFFICE USE ONLY <br />To: San Joaquin County FEXP. <br />7 300 Cj REF # <br />Department of Public Works CR # <br />PG&E E <br />(2^(�f / ] TO DRIVEWAYS: <br />(Applicant Name) <br />4040 West Lane AREA QUAD <br />TYPE <br />(Mailing Address) FORMS <br />Stockton, CA. 95204 NOTES <br />(City, State, Zip Code) <br />(209) 409-2083 <br />(Area Code -Telephone Number) <br />WAT8CcDPGE.COM <br />(Email Address) <br />F <br />ch (Detailed plans may be submitted) <br />SEE ATTACHED DRAWING <br />PM# 3/35oa�/ <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on <br />the side of K cktgGin Ale approximately 1—+5 ee mile C— <br />of W &b -5+e-r- RVe— S vc kfyrr , by performing the following work (description of work): <br />i <br />Work will commence on or after /J� �� forapproxima:ely 7 2 S / days: <br />I, the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Signature of 9pplicant - - Title �— Date <br />Y:TORMS B TEMPI TESIENCROACHMENT PE MJTAPPLICATON.&gO80) <br />