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AppLIOATIOiV`FORENC�OACHINT PERMIT: <br /> PLEASE PRINTt <br /> Date 's OFFiCEUSE`ONLY <br /> 1�. <br /> To: San Joaquin County JOB# REF# <br /> Deparfinenf of.Public UVorks APN CR# <br /> EXP:DATE <br /> VALID ib ii TO DRIVEWAYS: <br /> Gant;Name) STREET . <br /> { <br /> AREA <br /> LK L� TYPE <br /> (Mailing Address) f%` FORMS <br /> NOTES <br /> (City,state,Zip Gode) <br /> Ar <br /> i U j <br /> (mea Code-'.Telephone Number) <br /> Sketch(Detailed_plans may be submitted) <br /> �-- —' �' - <br /> The undeigned hereby appli for pe .,pissiQn o excav fe,construct and/or otherwise encroac n County Highway Right-of=Way en- <br /> Aw <br /> �1��1y1?/y) sidOe#: 1c�' � G' leges tri �pproxirrrately <br /> fee6ile <br /> Of— w , by performing the following work(description of work): <br /> � <br /> Work will commence on or about '' for approximately days: <br /> r <br /> I,the undersigned,.certity That I am the owner of the respecfive property,or am qualified o represent the=owner and agree to do the <br /> work described above in accordance with the rides antl regulations of San Joaquin County-and sobiectto rnspeetion and approval <br /> Signature of Applicant Title Gate ` <br /> E:wUasvwKvASI'MPSENCROACHMEWPE ,nTAPMCAnma.WC (01M) <br />