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APPLOA T ION FOR ENCROACH PERMIT <br /> PLEASE PRINT: <br /> '* OFFICE USE ONLY <br /> $ Date JOB H 116-10S7' REFM 0,0Az.-) J/l zf�rl <br /> APN - - - CRV# <br /> To: San Joaquin County Highway Department. Ey p, DATE0 <br /> /� \ VALID t �jY� TO /1az� DRIVEWAYS: <br /> AAybjgl ,F_o Geo � r1 i omm�n �_ STREET ' <br /> r (Applicant Name) AREA /od. QUAD lVev _ <br /> ' ' '^ TYPEID "dibf ..6.o r.<- <br /> s <br /> �Q S NoA7F} Wl lin VI�1y FORMS ss�i�i_ 2 z9 <br /> (Mailing Address) NOTE /�lke-t �of� tom-- ar EPS-io3-ovw <br /> )To-K7on Cq 95R OS <br /> r " (City, State Zip Code) <br /> Fyt 4 <br /> Co�09 � X67 / 00 � <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 'K' <br /> 3: w UN <br /> -£- <br /> : U- i <br /> � FIAT' S n o r F <br /> z GAS Sd ATion 'i M <br /> + <br /> o0z2e53 <br /> AP AVL. <br /> C <br /> i <br /> iv z <br /> i <br /> D_ �VA.cANT �� PRoPo9fJ MonilorinoJ WELL <br /> c. 4aca7�n <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County <br /> Highway Right-of-Wag on theIN�S i side of 5:-6A approximately <br /> R�F- mile Sav-r of C-19 p o( A ve n"k, ,by performing the <br /> followingwor : (description of work): ThZ'*6. 11011on of fro rAc WrAA-oR McAll r 'na -11 <br /> % ' 1 �E✓7/d o� will will 13F- !oo F£f4- be/au. 5vrF-4( Q o, A.9jat * DiArnetaf <br /> OnAt 409. iLLL - co <br /> Work will commence on or about a a for approximately�_days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualifies]to represent the owner an( <br /> th the rules, regulations of San County and subjec <br /> agree to do the work described above in accordance wi <br /> to inspection and approval. <br /> RojEci <br /> �— <br /> ( (J (J <br /> SIGN APPLICANT - TTIZE DTE <br /> t <br /> Z�ti <br /> �- <br />