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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Cate - r 17 j c <br /> OFFICS pgg ONLY <br /> To: San Jcaquin County J <br /> Department of Public CB # 750o71- 3 <br /> WorksREF # <br /> APN <br /> 14G11F"C (� iiL� r, EXP. DATE _ CR # <br /> �"� V �'t'tet �'l i St!' / / O <br /> (Applicant Name) VALID 10 (} <br /> STREET DRIVEWAYS: <br /> c, i C Fi Yr k I i. C AREA QUAD -- <br /> (Mailing Address) TYPE' <br /> FORMS <br /> J CZE lL '.-�-,�j C111 NOTE <br /> (City' State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate <br /> otherwise encroach on County Highway g <br /> {� construct and/or <br /> y Ri ht-of-May on the <br /> t_ approximate) side of <br /> of �' Y 4 feet/mile <br /> following work (description of work) : , <br /> EAu1 by performing the <br /> "dork :vi l l _ iP,lmencP ► ,Lw <br /> � <br /> s ' / <br /> as <br /> ---4-1L_— mor .1oproxi; at <br /> he er ;f <br /> - e 3z-:d agree _o 3,0 ;rer.I, r n <br /> n 'e ^' rK �"Srr zed lbo-.-e <br /> she=.__gin iopr.:3: . - i _ate 'Ind <br /> ) <br /> - `) <br /> i gra tore � �----------_--tle � <br /> f APP i<=ar.t <br /> mate <br /> i <br /> a <br />