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!'THU1 0 01 <br /> G. 002/003 <br /> APPLICATION FOR ENCROACIDMNx PERMIT <br /> PLEASE <br /> Date ., <br /> oFFTCE USE ONLY <br /> To.- *San Joaquin County <br /> Department of Public Works �ToB # 3 ►'?` -�. REF <br /> ASN 1 <br /> (Appl3castt Name} STREET DRxVEWAYS: <br /> AREA <br /> n r� �,� -fir , <br /> (mailing UAD <br /> Address) TYPE <br /> 1- FORMS <br /> C-k-7-P C& NOTE 17—7-T — G <br /> 2 <br /> (City, state, zip Code) <br /> Cti� 1 �►-�y ��.. -- <br /> (.Area Code - Telephone <br /> Number) <br /> —---�_ <br /> Sketcb (Retailed plans may be submitted) <br /> Li 1-4 <br /> The undersigned hereby applies for <br /> otherwise encroach.-on Count permzssion Ca excavate.. constr�xct <br /> Jnr QK S-TQ�c.-a; Y gighway__P'i9bt-of-Way on the.� cons r.1� _and/or <br /> of EI"t% a.c.i " ' <br /> app -side`�1 4 feet side Qf <br /> following work (doscra.ptson Of work} ; �� 4 sri�te +1S <br /> `� wr Q o ,C- T I Q � - w'x 5` F►.iwG��-fvrmIng the <br /> 1c..FL tI / K! ;arc S s(LL's r S�0 .WAL.Ism <br /> work _will commence on or ;about 'L <br /> ----� <br /> days.. i 1 <br /> y for approximately <br /> 1, the undersigned certify <br /> Z that T am ,.he owner of the respective property, or am <br /> qualified to represent the surrey and agree to do the work described <br /> acL:LQ�pecticn <br /> rdance with s, regulations of San Jos <br /> above in <br /> appxpv �� County and subject to <br /> Sign Lure Applicant - T:i.tle <br /> „n2TXR_,_-\Fa.:a�L r�. Date <br />