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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Nate -- <br /> - <br /> San Joaquin County JOl3 - <br /> Department of°uoiic'y' prk - REF <br /> APh —_____-.___ <br /> rR <br /> a ;_L .... _ _ - EXP.DATE s �t <br /> °20 <br /> 1E <br /> VALID <br /> (Applicant Name) To --- - <br /> - <br /> STREET r '�?1_? DRIVEWAYS: <br /> Ivv-{ P _x, PLAc� _ AREA QUAL <br /> TYPE <br /> — (Mailing Address) FORMS <br /> = src <br /> NOTES <br /> (Gity,State,Zip Gude) -------- <br /> �__ _-_._ <br /> (Area Gode.Telep_-_hone Number) <br /> --__ <br /> Sketch(Detailed plans may oe submitted) <br /> SEE ATTACH3:; p SKTC=,ES Z'OR CONSTRUCTIt N PLANS IN COI.?v Y' <br /> nT,:; _.. 7L ST fR H vhTRuU -'IkTS IF Nvfi7 ^u. <br /> EST'MFi.:) <br /> _PIS -SO"I'70A 3= <br /> The undersigned hereby appi;es for permission to excavate,construct and/or otherwise encroach on County Highway Righ#of-Way on <br /> I ERS T` side of M1cA:INi EY AVE <br /> pf YOSEMITE AVE <br /> --�- approximately c feet/mile SOUTH <br /> TREN01IN„ by performing the following work(description of work,;: <br /> R N-. ,NS'SA.* NC- CONIrUIT & CABLE THATCONTINUES N/W CF '71 r V^z F <br /> YOaS3C r> <br /> Pf - a.. <br /> :r: 4 MCKx?I_.LY r";vF M. E.RRA RD. WE WILL ALSO H .1ti'i <br /> E REP..,ACZATCa POLES i .C.NuL.'. -Ox <br /> _. <br /> _.._ <br /> ✓Uork wi11 commence <br /> approximately - - — <br /> — days. <br /> 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 n accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant True -- ___�_ <br /> '+II CI t STT AI t .!:^.G _ __h"?eTCi. Dat-e <br />