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Af PLICWON FOR ENCROACH: E N&ERMiT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date '> - 4- 0)-7 JOB # REFfl <br /> APN 42 /4f,/S's 1G CRV# <br /> To: San Joaquin County highway Department. EXP. DATE y7 <br /> VALID TO DRIVEWAYS: <br /> RA'q1g10Nt7 61PZC2 Cogs I STREET NES'`' 912- <br /> (Applicant Name) AREA QUAD t4 S <br /> TYPE <br /> FORINTS 5S1rz,cc�� <br /> (Mailing Address) NOTE <br /> E,5&rAw j.1, cAu FcP►1iA <br /> (City, State Zip Code) <br /> 2015)1-�31�- 55C) <br /> (Area Code -Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> /%t <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and!or otherwise a roach on County <br /> Highway Right-of-Way on the side of �Qlow�� (ZOAD ��2 approxi.mately <br /> --fit ,mile nvV-� of 61 vlc.e e- by performing the <br /> following Nvork: (description of work): Parn O OF- <br /> re <br /> F <br /> o� <br /> mt A At - �����1n( c�Qa�C� A��� �a <br /> Work will commence on or about - for approximately days. <br /> I the undersigned certify that I am the owner of the respective property,or am qualified to represent the owner and <br /> agree to do the work described above in acccrJance with the rules,regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> Sim-qAtdkE OF APPLICANT - TITLE DATE <br />