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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Datek I OFFICE USE ONLY <br /> To: San Joaquin County FN <br /> 73�SL-r- REF# <br /> Department of Public Works <br /> CR <br /> �l S 1l <br /> 1� VALID o f 0 f DRIVEWAYS: <br /> (AF�plicant Name) STREET per/ <br /> AREA <br /> Sf G ASI QUAD itlF <br /> TYPE <br /> (Mailing Address) FORMS <br /> rc4e--SNb (A NOTES <br /> (City, State,Zip Code) <br /> (Area Code-Telephone Number) <br /> 7Sk:etched plans may be submitted) <br /> 3Q3933 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County HighRight-of-Way on <br /> the � side of z t,�p�j approximately_ iz— • ile_ t-� <br /> of L", ' <br /> by performing the following work(description of work): <br /> Work will commence on or about I © t . <br /> for approximatelydays. <br /> I,the undersigned,cert iy 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 it accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> s7s't <br /> ignature of�,pplrcant-Title <br /> ae = <br /> EWU9-SV.WKIMASTERPSENCROACNMENTPi:?MITAPPIJCATION.DOC (01m) <br />