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Appal W- 1!ON FOR ENCROACH: {*PERMIT <br /> PLEASE PRIM]': <br /> OFFICE USE ONLY <br /> Date JOB 11 REFH <br /> APN o 97 - 5��0 -�_ CRV# 0 0 3 7 S' X <br /> To: San Joaquin County IEghway Department. EXP. DATE <br /> VALID /a_ TO DRIVEWAYS: <br /> �i•v�scrs �Gy t+�,Bi�'G STREET .Douce 4-ref <br /> (Applicant Name) AREA ! >-,:- u QUAD 1-1/ <br /> TYPE_7 <br /> Ry. Ba X SS'2 S 7 FORMS <br /> r <br /> (Mailing Address) NOTE <br /> , <br /> (City, State Zip Code) <br /> (Area Code -Telephone Number) <br /> Sketch(Detailed plans mw,be submitted) <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and!or otherwise encroach on County <br /> Highway Right-of-Way on the side of Ido U 6 Z --s "(,-- approximately <br /> 2,o a:F feet /mile of 11101A--C-6�c- A/15 )by performing the <br /> following work: (description of work'): ?'� � �-S�"' �'��`'�G 716-4J <br /> Work will commence on or about 3.1,"-& G 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 ilo iha Ivor d ribed above in accvrilance with the rules, regulations of ban Joaquin County and subject <br /> to inspection�d-ap r val. <br /> SI INA C)E-ATPLICANT - TITLE DATE <br /> e <br />