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n F <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> Date—Z — 2 5- 19� <br /> To the San Joaquin County <br /> Highway Department <br /> ZZ <br /> Gentlemen: <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway right of way by performing the following work: <br /> 2..J in [G7 /` L7nd Ctrs eollelCV4Q 3671 SOS.. <br /> (,Applicant will describe here fully what he wishes to dg. using reverse side if necessary) <br /> -Iro"4 tx �G V(. %/re L n xazl/ L- to c � Asa i <br /> untl L Sia ec19 tGe & K � o <br /> 1 . x, <br /> 20 �4,s . <br /> Space for sketch Submit detailed plans if available. <br /> II_ <br /> 7' / 0 1o t4 <br /> i <br /> 1 <br /> nn 1 <br /> On County Highway /74jjt7Sev1 Qd <br /> (Applicant ill state here a&uratcly & location of t e work he desires to do) <br /> and agrees to do the work in accordance with your rules aid regulations and subject to your inspection <br /> I <br /> and approval. <br /> Signature of:Applicant ! <br /> 37Z- W700 <br /> Phone Number r T <br /> C - 4 1kC <br /> A"eu C4 <br /> Post Office Address ' <br /> Permit issued: <br /> (9 PW-2419/a4) <br /> I <br />