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APIPtICATION FOR ENGROAHMENT P64 <br /> ERMIT <br /> PLEASEPRINT> <br /> Date Q Z Y OFFICE USE ONLY <br /> To: San Joaquin County JOB: REF# <br /> Departmer f of Pubrc Works ARN.; CR <br /> EXF' DATE `0 yr <br /> lfiA/C£D3� e �hv-ifOIINIlAA ?,n�,. <br /> VALID !y 0 �`� �2 DRIVEWAYS: <br /> {Applicant Name) STREET_ <br /> AREA' r QUAD <br /> 837 TYPE <br /> D1� <br /> (Mailing.Address) . FORMS W <br /> NOTES <br /> S?p . T. <br /> (C�tY, ate,Zip Gode) - <br /> � � y1#7. I oo <br /> aArea Code .Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Sz. A..cA.IFD SJ TZ <br /> Thendersig'ed Ibereby applies for Permissbn to excavate;:cons#ru t and/or ofherw�se encroach on County Hlgh" Right of-Way on <br /> 4 J'f N <br /> the w sideof' SRS st:>EL 8PProximately J�Ob ;fee ISov T <br /> of QCs }lMq.0-4: , byperformingthefollowing.work;( escnptionof.work) <br /> Mw-S(� „4w <br /> w I D 1J A Awd E w 9 M V_%Tib; DF3 &.�f► . <br /> y G�Qt t ► ��► d � �fiit I $5.V q to-1 ' <br /> em t <br /> Work will commence on or about rte..b Q 3r 1. 2,01 Z fora roximatel <br /> --- pP Y days. <br /> I,the undersigned,certify thata am the owner of the respecff property,dram qualified to.represent the owner and agree to.do.the <br /> work descnbed above:m accordance with#he;rulesand regula#ionsof San Joaquin County and s[�bjectto nspectionand:approval. <br /> rR�yE4 i <br /> MA§'JA GER <br /> u're of Applicant Title Date <br /> E:IPUBSV.WWMTERPS qZq'AC MENT PERMITAPPl1CA710N DX,(0j") : <br />