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APPLICATION FOR ENCROACH VI]4 NT PERI <br /> PLEASE MINT: , , <br /> OFFICE USE ONLY. <br /> Date D7 -3o- JO13U dos REFU <br /> APN - CRVtI <br /> To: San Joaquin County Highway Department. EXP, DA 10 / <br /> VALID '971571( <br /> 1( TO 0L DRIVEWAYS: <br /> NVANCEo (;c0E9vironer,e;1 0 .9 )OC ,; STREET Ca r x <br /> (Applicant Name) AREA LQUAD <br /> n TYPE So;rd t� : <br /> L ALN L} FORMS �VW ;)Q <br /> (\faiWlg Addres NOTE <br /> (City, StateZip Code) ' <br /> L <br /> PP SJ 14.P <br /> �� 30�{ F'. wEtsEl1 AvE . SRo Floor <br /> (Area Code-Telephone Number) s+ocklon CH A62ot <br /> £ <br /> 11 Sketch(Detailed plans may besubmitted) <br /> The undersiped hereby applies for permission to'e%cavate,construct and or otherwise encroach on County <br /> Highway Rie of Wa on the _Laryside of C. ^; l ��, approximately <br /> p / Fasrk of � �n /E?� , �o ,by performing the <br /> following work: ( escnpt*on ofwork�r r /Unn2 <br /> Work will commence on or about for approximately O / days. <br /> I the undersiped certify that I am the owner of the respective property,or am,quaMed to.represent the owner and <br /> agree to do the work described above in accordance with the rules,regulations of San Joaquin County and subject <br /> to inspection and approval, <br /> Yinn„u� !�- • �- S�RFF G�a�S�'s7 0`7`'30 � � � <br /> ,,SIGNATURE OF APPLICAi`7T TITLE DATE <br />