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API#CATION FOR ENCROACIVIT PEWN11T <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date 2JOB 9 7-3 &1 s/ REF# <br /> APN - - <br /> To: San Joaquin County highway Department. EXP. DATE 7// 7 DRIVEWAYS: <br /> G TE AREA <br /> TYPE <br /> (Applicant Name) FORMS -s s�T22 <br /> j430 W. CENTER --Tr- <br /> NOTE <br /> (Mailing Address) <br /> MANTECA, CA. 95336 <br /> (City, State Zip Code) <br /> CZ61?Z31QZG5 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted): <br /> T6 77Y /-DZ 711 = /Y I D f 7, <br /> NILE <br /> n 0- o <br /> 3( 1-51 <br /> IN <br /> Z15' _ /330 <br /> The undersigned hereby applies four ssion to excavate, construct and/or otherwise encroach on County <br /> High-way Right-of-Way on the njoie ri side of N ii E Ay approximately <br /> 13 30 feet h W2 I T of A/2100-2 T- , . 1 D ,by performing t~ <br /> following work: (description of work): <br /> Work will commence on or about /:!/9 9 i for approximately e) days. <br /> I the undersipmed certify that I am the owner of the respective property,or am qualified to represent the owner a <br /> agree to do the work-described above in accordance with the rules,regulations of San Joaquin County and subje <br /> to inspection and approval. <br /> 4L I�/ /I-- <br /> DATE <br /> SIG:�ATLPF OF APPLICA'N'T - TTII:E <br />