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APPLI&TION FOR ENCROACHMW PERMIT <br /> PLEASE PRINT: <br /> ` OFFICE USE ONLY <br /> Date 7`9 / 4 7 JOB # 7 3 7 2 3 REF# <br /> ApN __ CRV# <br /> To: San Joaquin County Highway Department. EXP.DATE-,' <br /> ATE DRIVEWAYS: <br /> VALID r TO <br /> �ACIFIG �EL� STREET <br /> (Applicant Name) AREA Go rJ'i QUAD <br /> u� <br /> TYPE <br /> .4.4 W- YDKUTs AVE sr _ FORMS — <br /> (Mailing Addressy NOTE <br /> CA . 95Zo? <br /> (City, S(ato Zip Code) <br /> -Zio 9 _ A4-7,4 ._ 44 D-77 <br /> . <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> TRFNCHING L CARL PLACEMENT DETAILN� <br /> 50' P3529 <br /> `0 EOP <br /> MIpTALC LENGTH 88' FT <br /> _---- CALIMYRNA RD CL <br /> c� PLACE IN <br /> . N ►D <br /> = EDP <br /> m NEW c� <br /> JP#P3536 <br /> NO SCALE <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County <br /> Highway Right-of-Wag on the 1`I S side of C-'AL16AYMMA SLOAD� approximately pn the <br /> 5 f8et 4pailc asT of 1=u N 1 CG MQA i7 - <br /> following work: (description of work): -ro -199.•lCR SS T 'ro "1' INRIFMLrrTj Kr <br /> E" <br /> iDus�.t lAGst E QZpSSkNCr CA Lt MY2 NA QD- OPEK C <br /> TrAUPAXRKA <br /> Z4 FT /4,KD SZRST17tZt1.\G Tb O�tGt�.cAL_nrr �r-"-""iF�Z. CO�1�tTtO1'�V� <br /> `— t3_ q M <br /> .t i F tC Et_t_ for approximately O N E days <br /> _ Work will commence on or about 4 15 <br /> ed to represent the owner and <br /> I the undersigned certify that I am the owner of the respective property,or am qualiti <br /> ., �to do the work descn'bed above in accordance with the rules,regulations of San Joaquin County and subject <br /> agrto inspection and approval. <br /> _ �.• i'2D Y 11�i C�E['Z.-� C'3E LL EN C(L <br /> SIGNATURE OF AP LICANT - TTTLE DATE <br />