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JUL Oe '99 1451 FR LFR L VINE FRICKE 510 652 2246 TO 9120903433 P.03/21 <br /> APP CAI ION FOR ENCROACHMENT PERMIT i <br /> PLEASE PR1NT: <br /> q OFFICE USE ONLY <br /> Doff D <br /> Date '� y - I JOB U S- REF11 Cr <br /> FIN CRVH <br /> To: San Joaquui County I Ii hway Departlneut. EX-P. DATE <br /> fie , (SDCD's) VALID? 7-f9 TO DRIVEWAYS: <br /> a <br /> qo alrT'. tB.c •we F ' a- % > STREET <br /> (Applicant Name) AREA -SF=4,c. UN <br /> TYPI ^ Ave,17700 Paalf.) -(' ee d /a t k F&- FORIviS 55 W U, R- <br /> (Mailing Address) NOTE <br /> V;)),o y f <br /> (Cit , State Zip Code) <br /> y,SaO <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed pias may ba submitted) <br /> U Wt- <br /> The undersimed hereby applies for permission to excavate,co_struct and(or otherwise encroach on County <br /> t <br /> Highway R:e t-ef--Way on the 1tJe5'✓' side of— r- approximately <br /> � <br /> ^ �0 fee ;mile Ne,.-� of A— by Performing L <br /> following,vork: (description of won): $0- ( gape - e "� <br /> �Vork Nvill conuuence on or about /999 for approximately days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner a <br /> agree to do tho work described above in accordance with the rules,regulations of San Joaquin County and subit <br /> to inspection and approval. <br /> SiGivA(T)iE F Ai'PLICAINT I1Tf 1; <br /> nT <br />