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APPLICATION .FOR ENCROACEMCM PERMIT <br /> PLWZ PRINT <br /> Date D'. OFFICE USE ONLY <br /> To: San Joaquin County. JOB # REF ,# <br /> Department of Public Works APN _ CR # <br /> EXP. DATE / <br /> VALID d& T6 DRIVEWAYS: <br /> (Applicant Name) STREET . 4flwknp .A <br /> AREA 15 kAl QUAD /y_ <br /> TYPE <br /> (Mailing Address) FORMS. ezfj Cl <br /> C T7l?!f [, lI �� D NOTE <br /> (City, State, Zip Code) <br /> V a � a�s <br /> (Area Code Telephone Number) o cn <br /> Sketch (Detailed plans may be submitted) O 'o=. <br /> To �- <br /> G 0 7K C7 <br /> K- t[ /yrGAs✓�r t? p C <br /> ell 5c' <br /> IWaddyeVS 'D <br /> o.L ZI <br /> Q< <br /> 8��. !��✓ <br /> The undersigned hereby applies forpermission to .excavate, con truct and/or <br /> /4 Ldwr A� PProximately Liv - ee � �de..of.... . ._ <br /> otherwise--encroach on -County.Hi Highway Ri ht-of-Wa oa the s <br /> Of '. Yz L!,Yom; / s , '��i�G %�1 by'perf ormi ftg the <br /> following work (des iption of:work) : <br /> 14 eg5' EZ4-7.q e <br /> Work will .commence. on or'about ass for approximately <br /> la V 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 /> dance with the rules, re * lations 'of San Joaquin County and subject to <br /> inspe tion and approval <br /> S1_2 <br /> Si atu of App icaat T tla ate <br /> laSPIDt.RB\8588 M (6/00) <br />