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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: c ,' :^. 'ECEIVED' ,n,;.l.►(�' ^+:t,��_.. <br /> Date 7 <br /> OFFICE 'USE ONT_Y <br /> To: San Joa y DEPT. �F i'UBLIL `/t7Ri�S <br /> gain County JOB #_J�S-Z- �o <br /> Department of Public Works REF a <br /> APN _ <br /> CR <br /> EXP. DATE g! rt <br /> Pr�ct�ic �.�/s � E[ c�I; co. <br /> vps,ID i7 To <br /> (Applicant Name) DRIVEWAYS: <br /> STREET ,e <br /> &,)s r Li9ivE' AREA --'�"� QUAD ----- <br /> TYPE $ELG yf(xzc i <br /> (Mailing Address) FORMS C��E <br /> s TOe x rnkl rioTE - ' <br /> (city, State, Zip Code) <br /> (2v q) VY2y'-7,q <br /> (Area Code .- Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> CCCE <br /> pin:3D'11 6 <br /> The undersigned hereby applies for permission to excavate, construct <br /> otherwise encroach on County Highway Right-of-Way on the and/or <br /> I,.A2NG1'' oqo a side of <br /> of —[�1q/�L!/� approximately 70 feet/_wA e <br /> following work (description of work) : O�p�/4 by performing the <br /> /3EL[. 604,d' I.YJE`fL L`4aS -.. . <br /> To _Zu gT/�GL / GE _'IfWI�I `oA1,0 <br /> Work will commence on or about <br /> °10 da s' "/?`D(o for a <br /> y pproximately <br /> I, the undersigned certify what 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 /> nature of Applicant - Titic Q� <br /> TO: Date <br /> MASTEe2.pS\FEESC-IDL (6/00) eq� �„_--}Q��� Q� � <br /> VU�+ PROMSSM ACS BW 1 <br /> STM , CA <br />