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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date 0 7 OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Pu'�bI�l"".ic Works APN CR' # <br /> y we'f4on EXP. DATE <br /> VALID TO DRIVEWAYS: <br /> (Applicant Name) STREET rNcF-UTVN 'RD. tP1 CR/lli<iJ <br /> AREA STocKTor.� QUAD 1_V <br /> z3,00 C fS #li- 21 TYPE 'Eowr- <br /> (Mailing Address) FORMS <br /> 5-�oc,L4,n CA `/SZlo NOTE <br /> (City, State, 'Zip Code) <br /> Zoy 4�y- y3�� <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Se�-_ MIA.4. awp <br /> A rt Sbb :6� L,�roe/, 5 08 <br /> c( a ' <br /> The undersigned hereby applies for permissio "to excavate; con ruct `and/or <br /> - otherwise encroach on C_o`unty -Highwa --Ri t of-•Wagon the - EAs! side -of <br /> THyowro,A/,. ,04 /A e' c 9t11 <br /> ely .,. feet/mile <br /> of � �„ by performing the <br /> following work (description of work) : <br /> ?f 7t, P/— yy"X21' 6461Aler Ampc,�&"Xto Co ejeirr£ P,#0 Ak�.,f �6 rxjfj.�f Teles Sax. n� 1Z k" <br /> (Akf ah 1 )0/•,k ptw Sox on Aa G 'f%or*hn HCl,*J Koro /4S/' -Z,,M on rMiKAIr Al <br /> Aeon �Y,� L�-�S• AT'r io go-i- 1-3" V8 rzo ANO T1aac4 /�r 2-5+• Pe-c '2,w4 s fa vim_ . <br /> a <br /> Work will commence on or about for approximately <br /> 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 /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of plicant - 'Title Date <br /> MASTRR.PS\FERSCHDL (6/00) <br />