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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date crr , / Z-d/ / OFFICE USE ONLY <br /> To: San Joacuin County JOB# REF# <br /> Department of Public'Works APN _ CR# <br /> EXP.DATE <br /> PC VALID / 1Z T' /S DRIVEWAYS: <br /> STREET 60)Q ar' e,p4-,c m <br /> AREA Wool; wD.E QUAD <br /> P(,;&E-FRESNO RMC TYPE -Etat)1-', <br /> DMD DEPT FORMS S-j W to <br /> 8 RIVERPARK PL EAST NOTES <br /> FRESNO. CA 93720 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed l:lans maybe submitted) <br /> / !� A'' .r l✓F �+� i�,!/z-GUS I.�J 9 /AZ'z C A� _ " /TA' s " ccL <br /> The undersigned h :reby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the So v t--r __side of L'J W CU p 6 /z4!9 e— PP approximately YC I S-/ feet/mi} <br /> of 6"rs i'ira�,✓ , by performing the following work(description of work): <br /> b <br /> __g-4S <br /> nC. <br /> �J✓a-✓I3 -r- LU CA-T. r £ 1u i- t-<'/uv /R �tQ �_,,✓clYa t- ���!J/4 ce, <br /> a,u4 c.. -. Gat cmc e e,A Pf, 7 <br /> Work will commence on or about_ /— 2 — U� �- for approximately t days. <br /> I,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 d n d above in d nce with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> EPUMV WKUASTER PSIENCROACHIAEN,PERKI APPLICAT IONDOC (01/06} <br />