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APPLICATION;FOR:ENCROACHMEK PERMIT <br /> PLEASE PRINT <br /> Date �' OFfICEUSE OfVLY <br /> To: San Joaquin C linty JAB# ��1z REF-1 <br /> Departmentof.Pubhc"sAPN R# <br /> y EXP.DATE <br /> VALID /ro // DRIVEWAYS: <br /> (Applicant Name) -STREET 41?v <br /> AREA / QUAD. <br /> / /� 1ff� ,+i ,Gp• TYPE. .EXE AAWI .end _. <br /> `(Mailing Address)-. FORMS 55 iz/i✓ <br /> ,� NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed-plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroachn County Highway Ri ht-of ay on <br /> the li L-5; ' side of .�i .5. i�-.C� lr� ,approximately / ,�a,ET <br /> `of6, J",rs1�G6 ,P�, by performing the following.work(descnption of work) <br /> �Ael140 J�9 -5 s A r .c2f�s �117_45 <br /> Work will commence on or-about. / for approximately 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 descritjed above in accordance with the rules`and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title a Date <br /> E:IPUB-SVWIMNSTER-PSENCROACHMEHTPERMITAPPUCATION-DOC tDIMM - _ _ <br />