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PLEASE PRINT: APPLICATION FOR ENCROACHMENT PERMIT <br /> Date <br /> To: <br /> San Joaquin County OFFICE USE ONLY <br /> Department of Public'Norks J013# <br /> APN REF# <br /> 'hC,l F-1 C- , L LD l3 l �'t EXP. DATE --- CR# <br /> (APplicant Name) VALiD /i TO <br /> STREET ___ DRIVEWAYS: <br /> L 3 U fl "! CL 1 U l s m, 1 LR 20/`D r R E ��__�_WQUAD . <br /> (Mailing Address) <br /> _ + FORMS <br /> L LC A �i 5 'Z i NorEs <br /> (City, State,Zip Code) <br /> C20 a Ll 1 4 - L4 Q31 <br /> (Area Code- Telephone Number) <br /> Sketch(Detailed plans maybe submitted) <br /> PLIlnS('L , iL KCLT H bl l <br /> fT Ri'Nf= I ''PLl C iW3r <br /> N L tl `�) A.U. C) AC i v,r1l` PL kG <br /> K I�ZC P <tiAj <br /> - --_ <br /> the undersigned hereby applies for carmi.G�;nn to excavate. construct and/or Otherwise --_-__-- ---_ _—� <br /> _- s:de of IL'1'�i2�f�oS�1 Nese encroach en Cn�"Fk <br /> approximately ��� unHight Of-'vYay on <br /> by performingthe f ' iie ZOS,6T <br /> oilcescription of work): <br /> . -u 3bo�,t gaP_ — <br /> a <br /> `or approxim y <br /> - - <br /> t� r r atei 4?>3`lS t <br /> 3bG,P:r ��Cur� e Y @r+�f ne respectil e orcpPrt`� __ ��S. <br /> e „ or am:j ' '� d to'F rn er <br /> arce � th :� , a arrJ a, � �a,� e p c t t a,,,, <br /> 'n r User art?�� r8e t_ <br /> a,u you^�J and »�Aetto 9 o o ;,7,, <br /> "SGFCt:cn 3nd apCrr,�+ <br /> � 7 I <br /> winature of APpijr_a4 1e - <br /> Ojte <br />