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AFPDLICKI IVM FOR ZENCR,01VACF81(tlENT Pl'=CaWH T <br />PLEASE PRINT; <br />Date 0 d 1, 2 2 C' <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR# <br />EXP. DATE <br />DRIVEWAYS: <br />TO <br />STREET <br />To: San Joaquin County <br />Department of Public Works <br />� a � �� <br />Ir a 8. C- ° P1 3 V 131VALID <br />(Applicant blame) <br />8dMR]'ffast Lane <br />AREA QUAD <br />TYPE <br />(R&Aflrog1 Address) <br />Stockton, CA,,95204 <br />FORMS <br />NOTES <br />(City, Stale, Zip Code) <br />(209) 373 —9432 i,(d2@pge.com <br />(Area Code e TOephone Number) <br />Sketch (Detailed plans may be submitted) <br />Soo Sketch. <br />Grew to call S0 County �nspeotor at (209) 953— 7421 48 to 72 hours before work <br />shirts. When oalfau`ug, Crow shall request " Un Clearance " for any work cd ufing <br />winter months Movernbor through Manch. <br />The undersigned hereby applies for permission to <br />the A! side of KeAeAA <br />of 4+r,�r'6i a 9A <br />commence on or about - <br />construct and/or otherwise encroach on County Highway Right -of -Way on <br />approximately a f e mile .E <br />des b , by performing the following work (description of work): <br />for <br />I, the undersigned, certify that I am the owner of the respective property, oram 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 />D"' 'r'. -/ 20'9 <br />Signature of Applicant . Title Date <br />Y:TORMSdTEMPNTE8IENCROACH4IEWPERMRMPLICATION.doc (NN) <br />