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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB 13-45!52--6 15— REF# <br /> APN _ <br /> EXP. DATE /l� is't CR# _ <br /> VALID <br /> (Applicant Name) ' <br /> l ` TG' ��-` DRIVEWAYS: <br /> m�?5 a'tJ r'2 <br /> T AREA - QUAD <br /> TYPE <br /> (Mailing Address) <br /> FORMS �y�a <br /> NOTES <br /> 2� ----- <br /> (City,State,Zip Code) <br /> (Area Code Telephone Number) <br /> Sketch(Detailed plans maybe submitted) <br /> -: <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Ri ht-of-W <br /> the Ce side of kv P6V=irK� y y ay on <br /> of �-y,� � approximately <br /> by performing the following work(description of <br /> Work will commence on or about <br /> for approximately <br /> I,the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to odays. <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and a Povth <br /> al.e <br /> P <br /> �1�t�Yure of Applicant-Title � �'�'f !� <br /> Date �— <br /> E:WU&SV,WI(IAb1S'ER.PS1ENCROhCHMET7p"rN,ITAP"_iCATION.DOC ;p M8, <br />