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Jan 20 12 11:05a Windmill Ridge Winery <br /> 2098330400 p.1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ! 2 n U <br /> (� OFFICE USE ONLY <br /> To: San Joaquin County JOB# V t� <br /> Department of Public Works Doc d- REF 9 <br /> APN CR 1,t <br /> EX?.DATE <br /> VALID -� <br /> (Applicant Name) STRi:ET I2 TO DRIVEWAYS- <br /> � � AREA S Se.e., yam'9 <br /> r <br /> L! k�c, t�-i QUaD S �..— <br /> (Mailing Address) TYPE <br /> CORMS W , <br /> NOTES,r A �9 ��3 oL/ <br /> ( Ity, State,Zip Code) <br /> (Area Code-Telephone N umber) <br /> Sketch(Detailed plans maybe sub s n d) <br /> The undersigned hereby applies for permission to excavate, construct and/or othe <br /> the side of rwise encroaeh on County Highway Right-of,Wa or, <br /> Of approximately feet/mile y <br /> by performing the following work(description of work); <br /> �- usr n �., w. <br /> Worts will commence on or about <br /> for approximately <br /> t,the undersigned,certify that!am the owner of the respective roe days. <br /> work described above in accordance with the rules and regulatins of Sac Joaquin alCounty and rsubject to inspection agree <br /> approval. <br /> Rp <br /> S' ature'of App r t• e ^� — 2-`' — '7 -- <br /> Qate <br /> tuurr;:vvnuuar�rrs"uu+*AM wWr TION.00C olfAlJ <br />