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^� - <br /> 8 2017- <br /> APPLICATION FOR ENCROP_CEIIENT PERMIT <br /> F--F-), 51.JQSE PRINT. <br /> 0Mis -71 J <br /> Date 11-5 I- OFFICE, USE ONLY <br /> To: San Joaquin County JOE a 73Z- _ REF 4 <br /> Department of Public works PPN CR, n <br /> �7 l EXP_ PIA,,Tz <br /> / <br /> V'P1 ID � .Z _ ? Z DRIVEWAYS: <br /> (Applican.t Name STREET <br /> VZZ,,f <br /> A �l.—ded w/QUAD�� IIF T'IPE iL�CL� <br /> (M _li_^_g 2 ddt-ess) FORMS $5 <br /> r� ,,,7 �/� Q NOTE <br /> (City, State, Zip/Code) <br /> (9ze) 2-70-230 <br /> (:a-rea Code - Telerhone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> 1?i r"W5 �► �cti�-�}{-'-� CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> T-ae undersigned hereby applies for permission to excavate, c ns/Itruct and/or <br /> o-nerwise encroach on County Highway Ri ght-of-I a,i on the or h side of <br /> 5nn�u �/ uz approximately <br /> e✓ Ave-In b,r performing the <br /> following work (description of work) : <br /> 12Z 92 .!RCS l 4VA <br /> •~ 1 Cal C f� nBr-�n c: r �re'�� Y't�or��;rr� <br /> work will commence on or about for approximately <br /> r>O days <br /> I, the undersigned ce-rt_ifv that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin .County and subject to <br /> inspection and approval . <br /> t 11L <br /> _ �"cart Title Date <br /> NrS c�.PS',rEESC-�2. !n/C0� <br />