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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date O OFFICE USE ONLY <br /> To: San Joaquin County JOB ##_ ,l/D > <br /> - REF ## <br /> Department of Public 1 Works APN CR' 4 <br /> d0k)6 QU(�(J0N 10- . EXP. DATE 7 LS- €3 <br /> VALID 3-G2 TO Z2 DRIVEWAYS: <br /> //\\ <br /> (Applicant Dame) STREET•�/go�J-�. 6"L-r <br /> 1)o .. &lv l0 2 o AREA i P-AC`/ QUAD SC <br /> TYPE7��i 'Ge'v Si.r�At <br /> (Mailing ,Address) FORMS __61 ,�,� <br /> J�• (��l�+�Z,��1S Grp y,�� �o NOTE <br /> (City, State, Zip Code) <br /> 33 �( • 1�,? <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> JoUo i6 ,4�.� �S�r�a��s <<���r) ✓ A, Cris /-�d-5 <br /> �'�L ��/`�lL��(.LN�/9'�i.G'IUC�(LS �/�'LC �G�� I�C3i l/`/(X•� <br /> CAJ064,K OAXY . '7:0 o A,.n — Tod(H- <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on-the side of <br /> approximately feet/mile <br /> of by performing the <br /> following work (descript:iorl of work) : /'i9 ,_ CLaud2(1 d 06-t- <br /> Work will mmence on or about J -22 •Q& for approximately <br /> rl 7 r(U xl l Yz days. <br /> I, the undersigned certify that I am the ovmer 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 a royal. <br /> 17, d6 <br /> S' na re plicant - Title Date <br /> MASTER.2S\2EES=L (6/00) <br />