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T <br /> ` APPUCATION fOR ENCROACHMENT PERMIT <br /> ' PLEASEP.:RINT, <br /> y Date Z 'l Z <br /> OFFICE <br /> Date <br /> rt <br /> To: San Joaquin County ,JOB# 73G�S"Z—� REF.--# <br /> sr DepartmenfofPublicWoi�s APN CR.# <br /> _ _ EXP:DATE 2 2+ !z <br /> r ��'�t<, ` �l l !� VALID 2 21 !i TO Abe i DRIVEWAYS: <br /> (Applicant Name) STREET L dip ,q . <br /> AREA `�T ✓ QUAD <br /> TYPE GE Pd✓a�sm <br /> (Mailing Address) FORMS .rs wi✓ <br /> NOTES <br /> s SCK- ;' Q <br /> (City, State,Zip;Gode) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) _ <br /> f S 7�1c17/v <br /> �T7 ��s(C �e%116 6(1 Vl i-/1�i i� �� C <br /> Cfa►�e oc�f,c��f5, �g�� <br /> -I-i�✓`� (,OOA" � uo +� eGSESAO, ^eA5ydaafd <br /> - n A,M. Ta oo P. y ��yL��aTr/Ou,25 <br /> DrVL y! <br /> 7he.undersigried hereby applies for:permission to excavate,'construct and/or otherwise encroach on County Highway Right-of--Way on <br /> the side of` j� ( r G� approximately feeUmile. <br /> of by performing the following work(descn tion <br /> GI }of work,)_ <br /> t CSC �tZr1' �L CC e c!z<lU � 71 P�� 1Fff- /fit; s <br /> IVI`_ l WlL L -� t1t, G ( G'i l !_ RI L. 7�-75 . <br /> TT <br /> Work vinll commenceon or about t.— for approximately days. <br /> (,the undersigned,certify that l am fhe.owner of the"respective property,gram qualified to represent the owner and agree to do the <br /> wort described above.in accordance>wi.M the rules and regulationsof San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> EMU8-W.WKMSTMPSFII YENTPEia6VAPFVGnptDDq(oiMM - <br />