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AP*C'ATInN FOR ENCROAC HONT PE&NHT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date JOB 1 S I REFO <br /> APN - - <br /> To: San Joaquin County Highway Department. EXP. DATE /1 Q DRIVEWAYS: <br /> C TF AREA Fv P A,ve- Ch'4,tf") CS 0 ' <br /> TYPE `IrC-• k <br /> (Applicant Name) FORMS s�-/wit/ , k 2-2 <br /> '430 W. CEII TEi ST'j. <br /> NOTE <br /> (Mailing Address) <br /> MANTECA, CA. 95336 <br /> (City, State Zip Co(M) <br /> Z09 239DZL5 Z/ <br /> (Area Code-Telephone Number) 'r�Do�V/ <br /> Sketch(Detailed plans may be submitted): <br /> ti <br /> MUC E l80' <br /> OT�E'K�1 �j <br /> C�EU <br /> E/P <br /> k N a' <br /> oh <br /> F/G ,Av0JUE <br /> 4 <br /> The undersigned hereby applies for permission to excavate, construct and i or otherwise encroach on County <br /> H,ighwav Right-of-Way on the ,e/ale-77-/ side of /:-/C 4yEw 4,C-" appro?amately <br /> i B o feet /fie wFs r of by Performing th <br /> following work: (description of work): 7E71/Cl� 30" d E7°TN 3 OX�f 6C o f" <br /> P,4y&-ML--2UIO2 eoA?E �2/yCi.j.4YS VACS sa JOWIgE <br /> Work will commence on or about /nq-/2 C/� �, /97''7 for approximately�_ days. <br /> I the undersigned mnifG•that I am the owner of the respective property, or am qualified to represent the owner ar <br /> agree to do the work described above in accordance with the rules,regulations of San Joaquin County and suojec <br /> to inspection and approval. <br /> STG A TLS F OF A PPT IC a LNZ' - =E DATEE <br />