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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRIM: <br /> Date 6 Za/a ao OFFICE USE ONLY <br /> To: San Joaquic County JOB# �`d�^ REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE /-08 <br /> f e,Af-r 4CC I; 94,baO 'a / C,. Qeo-1A4 VALID e,'- <br /> r,e-,cam$ 70 p a� DRIVEWA"S: <br /> (Applicant Name) A-A--C— STREET 111-17AIelr RD ' <br /> AREA QUAD _4 W ' <br /> 74Qd t1.1 .4_y TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> _�- <br /> (City,Statdf,Zip Code) <br /> ?a-� <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> �N�4-� i4TT/4C NGis:�1 <br /> i <br /> i <br /> f <br /> The undersigned hereby applies for permission to excavate, construct andfor otherwise encroach on County Highw Right-of-Way on <br /> the a Al side of�Er�r� CJI] approximately �'� Y( eescription <br /> of /'r;' �^ - by performing`he foilawin,worof tivork`: <br /> zGla- <br /> Work will commence on or abou __ _ - L ,a$ for approximately � days. <br /> 1, the undersiogned,cer*that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance)Arith the rules and regulations of San Joaquin County and subject to Enspedion and approval. <br /> 1��2; Ce <br /> ur-R,4C.TVX_ !(,;? ifafo8 <br /> Signatuf'(r/e of Appkcant- it{e � tG AACAd.E Date <br /> "FUF JY'!!!YMSTEP �R�11 J�APG?!OH00^(0..76� <br /> Z 5EZ6-69E'>-96Ei alaa�r) eNipd dt7n7n Q.r; ni um- <br />