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say., ""�wv� lev+lfr�rvl 3 <br /> IT' <br /> % APPLIC TION FOR E CROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE TSE ON Y <br /> To; San Joaquin County JOS# REF <br /> Department of public Works Ap�N CR <br /> E>�P.DATE I —20 I _ <br /> LID l1?—rp —1t 3 DRIVEWAYS: <br /> (Applicant Name) 8 REET <br /> A EA QlJ • <br /> PES <br /> (Malting Address) F RIMS <br /> i(�1o3z N,TEs <br /> ( Ity,State,ZIP Code) <br /> �I35- '�• o-rz v <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> 5L'� �.• A�v+i� � �et was, <br /> oa �c��*� �s tm�ta i5 vf�w�l, Wt Art retlkc t4, 6t <br /> c e � <br /> OV¢el ewt �rahrJ, wire., tl W�r1G t�� b; �t�arwe4, on exzs i;V) <br /> S ?s a*r1 t�w.lok G� �i' Zap KV •lewcr cTar,,, <br /> �ups <br /> ti ;,� � �� �, rti pre �M, <br /> o4AwI <br /> The undersigned hereby applies for permission to excavate,const/ict and/or otherwise encroach n Coun Highway Right-ofWay on <br /> the side of ' approximately feeltmiie <br /> of ,by performing the )lowing work(description of work): <br /> Work will commenoe on or about for approximately days, <br /> 1,the undersigned,certify that I am the owner of respective prop00,or gin qualified to repres nt the o net and agree to do the <br /> work described above In accordance with-the rule i and regulations of San Joaquin County and su ect to I speollon and approval. <br /> lgnalu a pplicant-Title n <br /> �to <br /> craaxxausmus�+aa�n�e,tre+►+r wttnouroo pup, <br />