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APPLICATION FOR ENCROACI K pERNT <br /> PLEASE PRINT. <br /> Date , <br /> To: San Joaquin County OFEK <br /> Department of Public Works JOB# REF# <br /> �� 5.- <br /> APN <br /> EXP.DATE CR# <br /> 'teVALID 3 <br /> (Applicant Namee)) STREET T l ll DRIVEWAYS. <br /> Z.? l 7 C; S AREA ` <br /> (Mailing Address) <br /> TYPE -'' t ' 1 <br /> FORMS g� R-7�j ' <br /> -T'rL1 C. �r, NOTES <br /> (City, State,Zip Code— — <br /> (Area Code-Telephone NLI-M r) <br /> ; Sketch(Detailed plans may be submitted) <br /> r <br /> i <br /> I <br /> The undersigned hereby applies for permission to exc vate,construct a <br /> the t��4 ,— side of ±_ �z_c . ,�r r2 c and/or otherwise enc <br /> Of 2 on Cly . <br /> r, _ approximately? o 4. gh" f-Way on <br /> ,by perforrrrmg9 --� <br /> (4ew r fworlr}. <br /> Work will commence on or about <br /> 1,the undersigned,certify that I am the owner of the respective property, for Proximat�Y <br /> went described above in accordance with the rules and regulations p PertY,or am days. <br /> of San Joaquin Cofurtttoo <br /> the Gwrw and representagree to do the <br /> ``� �Wy and subjecttD 1. <br /> Signature of Applicant-Title <br /> E:wto& L <br /> - "STFR.PSIEPICh'OACHM[NTPEFTMIiAPPI!CAT:�.pp� .� Date <br />