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APPL�ATIO • <br /> N FOR ENCROACHMENT PERMIT <br /> PLEASE PRL�IT: <br /> Date 3-/z.^ 97 OFFICE USE ONLY <br /> JOB H 73 o REFd <br /> To: San Joaquin Cour Highway APN " t- CRV# <br /> �'ity Y Department. EXP. DATE J /S �7 <br /> VALID x 9 TO DRIVEWAYS: <br /> ST R.EET/,u v�„r �.e <br /> s <br /> (Applicant Name) AREA QUAD sLo <br /> yy w y')KllTs AVE- TYPE <br /> (Mailing Address) FORMS 5 s/c,� w, ,e_Z y <br /> NOTE <br /> SrkN . C-A, 9S2o 7 <br /> (City, State Zip Code) <br /> 205 `/7N- ` 2.s-t/ <br /> - (Area Code-TeIephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> . s - <br /> o n <br /> SLC AMAC-tf EM 17214�NINCr c --' <br /> WHEN , BlLl.% W(rr�LE�.SC ZF R Tb X03vr$39f�ti ' i-TI <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> ffighwayRight-of"Way on the -r v4 side of PINI'14AVEN -�R. <br /> oo feet /mile Q, of 181 appro?rimately <br /> following work: (description of work): /-2 <br /> A c v CA ,by Performing the <br /> A -D SPLIC%vIG 3 �41�DITIoNHL SEKVtC� L/1Ve-S <br /> _ Work will commence on or about MARCH /8 I S for approximately / days, <br /> is <br /> I the undersigned certify that I am the owner of the respective property, or am ed to <br /> agree to do the work described above in accordance with the rules, regulations of Joa sent the owner and <br /> to inspection and approval, <br /> g� ' ' gain County and subject <br /> SIGNATL OF APPLICANT - TITLE - 3-1 Z— 97 <br /> DATE <br />