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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> To: San Joaquin County <br /> Department ufPublic Works APN <br /> VA TO DRIVEWAYS: <br /> (Applicafit Name) STREET <br /> AREA QUAD <br /> ('331 TYPE <br /> (Mailing Afdress) FORMS <br /> SV <br /> PtY,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) IPIC-,ns A-T-rAc i-#rc—o <br /> 'iA Ci <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-offay on <br /> the.- We5+ -side of PA%As approximately AW <br /> by performing the followim ptil <br /> (rcdl ion of work): <br /> WOI�will'commence on or about— Av for approximately days. <br /> 1,the undersigned,certify 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 inaccordance with the | d regulations ofSan Joaquin County and subject 1ninspection and approval. <br />