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JUL 08 '99 14:54 FR LFR L VINE FRICKE 510 652 2246 TO 912093433 P.1221 <br /> APPI WA'TION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date _ r, JOB JOB i1 ! ,— REFrt <br /> ApN � .T CRVa <br /> To: San Joaquin County Highway Dep<v-tment. EXP. DATE__ <br /> C�,vol—Cw„ , frv:- .......�-e +'��ik••T.�rt, VAL11) .s/ �' TO _P-3o-r5 DRIVEWAYS: <br /> y+w` A�aa.+✓� , r�s,...kc, STREET <br /> ((lpplicantNa�nc) AREA -S�c �� QUAD <br /> s <br /> VO �JonaPd.` T- Trarc,c/Ca.<, .0'R 4c0,iwe F' YPE_ Berie x <br /> i�oopo 1Z'-kRg-y- rORMS <br /> (tiAailing Address) NOTE <br /> C/�L 9y'6o e <br /> ,ty, State Zip Codc) <br /> (6/0Z Cosa ~ ysoo <br /> (arca Code-Telephone Number) <br /> Sketch(Detailed plans may br submi»:.d) <br /> o/3 (J <br /> The undersigned hereby applies for petmission to excavate,construct and/or otherwise encroach on County <br /> ILghway IZ oht of V ay on the o� side of a eft rt approximately <br /> 6U feet malt Eos VU){ of my-� W��D� A 6`�� performing Ille <br /> following work: (description of work): <br /> Work will commence on or about Vii•` for approximately e3, ^ days. <br /> I the unde;si_ned certify that I am the owner of the respective property,or am qualified to represent the owner an <br /> agree to do the work described above in acwrdancc with the rules,regulations of Sin Joaquin County and subjec <br /> to inspection and approval. <br /> SiG13P.TURE OF 11PPLICANT - TITLE DATE <br />