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APPLICATION FOR ENCROACHIMLi NT PEIL'1TIT <br /> PLEASE MUNI' <br /> ]] / OFFICE USE ONLY <br /> Date TOE # REF# <br /> APN . t? _ - 190 - o! CRV# z_ <br /> TO San Joaquin County I-hghwa� Dep iment F—%2, DATE w 1 .i c- r <br /> Vr'LLID 1 TO / DRIVE,WAYS: <br /> STREET C u , t e- <br /> (ApplicAnt Name) AREA QUADM133 0,),, ZValAl 417-� ":;-I- TYPE. 6e S 4e--5-—11 <br /> FORMS <br /> I] (IN ailing Address) NOTE <br /> 556C%L7 Cr¢ 5�;-2_c,3 <br /> (City, State Zip Code) <br /> C" 464- 12-f _. <br /> (Arca Code -Telephone Number) <br /> Sketch (DStaile� plans may Lr"r' subrmt"� q <br /> The uudersaped hereby applies for permission to excavate, construct and!or otherwise encroach on County <br /> ?iighway Right-of-Way on the!V 15 side ofssr E _-approximately <br /> feet /male of , by performing t <br /> following work (descnptaon of wor%j. 5a v� ' u ea ►� z a. �« rr� r�- , 0 .:., <br /> S'd!rd` w (DA+�u,"u W <br /> UYt <br /> Cdr' <br /> Work will commence on or about 067-V6,CF2 20 for appro-amately-�days <br /> Z the undersigned certify that f amt the owner of Lhe respective property, or ani quah ied to represent the owner e <br /> ;isree to do & work dcsc nbcd ;above in accorO.-mw Nvath the rules, regulations or 5.uz Joaquin County and subj <br /> to inspccti and approval <br /> /fi lu�� 1CrCf/ y 27 <br /> rATURE OF APPLICAINT - TITZE DATE <br />