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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department ofPublic Whdm <br /> CDDA E i5-,98 <br /> AL wlve <br /> TO DRIVEWAYS: <br /> (Applicant Name) 4 STREET <br /> AREA A946 I/ QUAD 154V <br /> TYPE <br /> (Mailinj Address) FORMS <br /> NOTES <br /> ILI <br /> (City, State,Vip Code) <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The under d hereby applies fpl,permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> Igne <br /> �,2 approximately <br /> the side of -feeVmile <br /> of--- by performing the,following work(description of work <br /> IL <br /> Work will commence on or about <br /> |. the undersigned, certify that| amthe owner ofthe respective property,nromqualified hjrepresent the owner and agree todothe <br /> wo scrila,ed,.a�'in accordance with the rules and regulations ofSan Joaquin County and subject tuinspection and approval. <br /> r'Signature of Applicant-Title Date <br /> - /. ` <br />