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RECEIVED <br /> MAY 0 4 2012 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> FRESNO <br /> PLEASE PRINT: OMD/DPD <br /> Date 4 1 Yi fy 2 OFFICE USE ONLY <br /> To: San Joaquin County JOB# 7�jD c1-� REF# <br /> Department of Public Works APN CR# <br /> .1, EXP.DATE /2 .7- <br /> VALID <br /> VALID to S/Z "T6 ah Ii DRIVEWAYS: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> <L\\wL _ q TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> c k(g) 1(00 _,S 5,11IS <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 6'ez pe—m -V&-n c c�,sirlC�l <br /> The undersigned hereby applies for permission'lo excavate, construct and/or otherwise encroach on County Highway Right-of-Wy on <br /> the 0 side of MK%vSIT approximately (9,22 fee li'ey�J <br /> of (_0rlE by performing the following work(description of work): <br /> Work will commence on or about approximately 4zi421 <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 described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> e'Le----wtc 14 lz <br /> Applicant-Title Date <br /> E:V'U&SV.WKVAASMRPS1ENCROACHMENTPERMTAPPUCATION.DOC (0108) <br />