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ti <br /> 209-433-3990 <br /> p.7 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ 7Z ©j_ <br /> OFFICE USE ONLY <br /> To: San Joaquin County FEXP.DATE <br /> ESQ Asn Department of Public Works REF r � <br /> �U CR# <br /> Ger¢S, g En <br /> ^e2r nC QPcI"P t�Jprrt¢ni L�C{Applicant Name) O DRIVEWAYS:/ <br /> 3 S! dZ u c5S Qo' AREA — C,UAD ' <br /> _— TYPE <br /> (Mailing Address) FORMS <br /> �c <br /> per, � C A 9f S-3(06 � NOTES <br /> {City,State,Zip Code) <br /> —.--- <br /> {Area Code-Telephone Dumber) <br /> sketch,Detailed pans maybe suumittedj-- ,_.__. — ---- <br /> i <br /> S .4 <br /> i <br /> I <br /> Tf,e undersigned hereby applies for permission to exca ate,constru <br /> the 4'e-C.4- side of ct and/or otherwise encroach on County I lighw2y Ri t of-lNay on <br /> 5_ f�c/y ,� <br /> of l h_sk�. �S/may h ,Qanproximafely-01v- *A: -cl fee it i4fo.+4ft? <br /> u by performing the following work(description of work): <br /> r t onf �S04 1 6 <br /> s d Ca//t X-311SLJi an/ r�virG/rlcsQr 'Sctrn 6�0 . <br /> bVork will commence cn or about +� I ,�00 F� T <br /> far approximately o� nays <br /> t.the ,indersi ned,certify that: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 with the'u'es and regu ations of San Joaquin County and subject to inspection and approval. <br /> rWXS7Z <br /> Signature of Applicant-Title <br /> Date <br /> .._e�rvr-+a��:rs+��<cacrw�u.Fralr�a�c�iraaooc r.roer <br />