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APPLICATION FOR ENCROACH16ENT <br /> PLEASE PRINT: �v "7 A 10: 56 <br /> `: I�Ei Svc blSi ;f t F,r <br /> Date <br /> To: San Joac(uin county JOB :4 cur T <br /> Department of Public Works a CR rt <br /> EXP_ DATE <br /> VALID 4, oto TO ( to DRIVEWAYS: <br /> G STREET 3- '/��f L1,iE(3 AAs2FlEll// , <br /> (Applicant Name) (r <br /> — QUAD IJE <br /> TYPE <br /> 7!J Li !01/L�c�✓ � YPE -EAI sUy� � gD�2ES <br /> TYPE <br /> (Mailing P_ddress) FORMS <br /> _ NOTE <br /> (City, State, Z_:p Code) <br /> (Area Code .- Telephone Number) <br /> Sketch (Detailed plans may be submitted) / O 7,% 7/ <br /> Aw V <br /> L) � �f <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise Encroach on Cotmty Highway Right-of-Way on the .4Tn95hKPr <br /> approximately _ feet/mile <br /> of by 'pe'rforming the <br /> following work (description of work) <br /> Work willcommence on or about Gs r'�� o206 .61-t for app o*J m¢tely <br /> 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 <br /> pproval_Signature of RETURN PERMITS TO: Data <br /> PGM <br /> MF.STEE.PS\FEES ?. !6/00) SOS PRO�C//�����.//��\ ��� '�ESK- BLD <br /> 1 <br /> 40 0 �7�OL U W � 1 <br /> STOCKTON, CA 96204 <br />