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� t <br /> IL <br /> APPLICATION FOR ENCROACHMENT PER* -EIV ED <br /> r x, 0131- rN C0(J1• <br /> PLEASE PRINT: <br /> 006 APR 12 API 10: 49 <br /> Date �w�`�w OFFICFF U O <br /> DEPT. �r PHL?NiORKS <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. -DATE <br /> VALID /7 O O AdIIS-A)& DRIVEWAYS: <br /> (Applicant Name) STREET ST <br /> AREA STi�ei✓ QUAD 5� <br /> TYPE !aK41-AtA&e TiQEAl--H <br /> (Mailing Address) I FORMS _ *eA, y, Zg <br /> olf NOTE <br /> (City, State, ZJ'.p Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> pm: 34 t 14&1 <br /> oq�arzl : I0i386& <br /> The undersigned hereby applies for permission to excavate construct and/or <br /> otherwise encroatcA on County Highway Right-of-Way on the side of <br /> approximatel PIV feet/riR ! h <br /> ofby performing the <br /> following` work (description of work) <br /> Y` <br /> —�_ & o 1 <br /> Work wi 1 commence on or about for approximately <br /> 0 days . <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent thea 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 /> raturef Applicant —Title Date <br /> (6/00) PER •S •O: <br /> Pam <br /> aIOB PFiQCESM40 DESK- BLD 1 <br /> 4W Vftd Lw* <br /> X71 CKTM, CA 9MV4 <br />