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APPLICATION FOR ENCROACEIENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To San Joaquin County JOB # REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE 71 D( <br /> VALID l J TO DRIVEWAYS: <br /> (APel `caan�tName) Q STREET T <br /> QUAD <br /> ,C-J- . <br /> AREA STie.f/ _ <br /> TYPE .-'s/ <br /> (Nailing Address) FORMS 55 <br /> 015-9-Z NOTE <br /> (City, tats, Zip Code) 4 <br /> fly 7 <br /> (Ar4a code'- eleph n Number) <br /> Sketch (Detailed plane may be submitted) <br /> -ro <br /> toe S4 L);QE <br /> The undersigned hereby applies for permission to excavate, cqn trust and/ r = Z <br /> otherw' e-enc oc on County Highway Right-of-Way-on-the se.. 0-X <br /> G �`'' approximately �?�l fee ile z <br /> of �y "per€orM _FtheS�- <br /> following wor (description of work) : _ '� _<: <br /> 7v N <br /> Work will commence on or'about for approximately <br /> days. <br /> I, the under 'fined certify that I am the owner of the respective property, or am <br /> qualifie to represent the owner and agree to do the work described above in , <br /> accordanc with the rules, regulations of San Joaquin County and subject to <br /> inspecti and app oval. <br /> r <br /> Signature of Applican itle Efate <br /> bMST3R.PS\F88S®L (6/00) - <br /> i <br />