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` PI,ICATSON FOR ENCROACHMENT PERMIT <br /> A <br /> PLEASE PRINT• P pFFICE rsE p�Y <br /> Date "d� 7'IAJrZ'� <br /> F7.— —JOCR rt <br /> To: San Joaquin Count)r APN 2 k-o(o <br /> of Public Works EXP VALI <br /> DATE DRIVEWAYS= <br /> Departmen�r TO 12 <br /> D 2� * _--- <br /> P�C/F/C LAS ELECT. �0 ' STREET <br /> ����,,,,��,,,,���� AD �'-�---- * —"----- <br /> (APPlicant Name) AREA Lam`pp—gQUHp16, ------- <br /> TYPE Ghg <br /> yv yQ Lc/CeS'r L/gNE FORMS <br /> (Mailing Address) NOTE <br /> 95�v� I <br /> .9 7-421f 4f/1 <br /> code) <br /> (City, state, Zip <br /> -H '- <br /> (pi Code - Telephone Number) <br /> (detailed plar�s may be Submitted) <br /> keS— m <br /> O <br /> .M Q <br /> eaC= <br /> c%a <br /> PM 3DY`�Y�q� <br /> excavate, construct and/or <br /> for permission to Ri�Thl sideSof <br /> ed hereby aPPlies on the y`C Y <br /> The undersign hwa Right-of-Way feet/�� <br /> otherwise encroach on County H1approximately <br /> by performing the <br /> 21LN )gyC <br /> of �� //�- rF r <br /> tion of work) • <br /> following work (desc:rip KEti( S j��— 14 IP-- <br /> 7% SE2JE <br /> for approximately <br /> work will commence on <br /> or about <br /> days property, or am <br /> am the owner of the resp <br /> ective <br /> certify that I do the work described above in <br /> I the undersignedagree to in County and subject to <br /> qualified to represent the owner and g <br /> accordance with the- rules, regulations of San Joaquin <br /> inspection and approval. <br /> t _ T tl= FtETl1RN pERM1TS TO: <br /> f Appl�.ca~ngiiatnrc u ��{��[�/���CE� <br /> MpSTERO <br /> .PS\FEES"IDL (6�a0) �Y P • MSK <br /> - <br /> CA 9504 <br />