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APPLICATION FOR ENCROACHMENT PERI CE I V E <br /> PLEASE PRINT: 2006 APR -4 AM 10' 50 <br /> Date / V D'PIC5i—W3O?tL'�I0RKS <br /> To: San Joaquin County JOB REF <br /> Department of Public Works APN CR ff <br /> EXP- DATE Dpi <br /> �C VALID ' 4 TO DRIVEWAYS: <br /> (Applicant Name) STREET A4)1'1'EQ. <br /> AREA W� JAD <br /> W QT <br /> V0 qt) TYPE — <br /> .5 <br /> (Mailing Address) FORMS <br /> NOTE _ <br /> C ; g15 ? c> <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the :5out4 t-, side of <br /> AA ( ,eU A(267 — approximately Go- feet/mile <br /> of I,d 4.1�C1L1 L�4'►�F1 Shmeby performing the <br /> followin work (descriFtion of work) : A&A9 AP,/ tS — <br /> Work will commence on or about �ZZ�D for approximately <br /> To days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval._ <br /> Signature of Applescart - Title Date <br /> RETURN PERMRS TO: <br /> MASTEa2.PS\FEES=L (6/00) <br /> '008 PROCESSM MK <br /> 4440 Wilt Lams <br /> STOCKTON, CA 9&W4 <br />