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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date � � [ <br /> OFFICE USE ONLY <br /> To: SanJoaquin-County J <br /> OB Qapif <br /> REF# <br /> Department of Public Works CR# <br /> - <br /> VALID <br /> (Applicant Name �,� 0 DRIVEWAYS: <br /> ) STREET <br /> JtJ <br /> 5555 F_ Q(I Ve. AREA QUAD <br /> TYPE <br /> (Mailing Address) FORMS <br /> Pi�e Sr,- CA- Q 31 a� NOTES <br /> (City,State,Zip Code) <br /> 5S -494-3B i <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> AT4T --z e, sig CK---a rJ <br /> Yrl q I(AWrdX BYO 4A_ V +0 12K 1 S7'(i\l C-- CA-f3I W CT <br /> AfP <br /> LfS� F:�-,r, VgAD 1--a 'P61-G P&Q 1'�emove _4_R_ep1A-ce 10 - �;CLFT ra ) <br /> e_b N e_F� G A-T- SA-� / 'P1 qtE (o8'"K t`o '' C_6 0.c-P-C---rE- -P 6-b <br /> t7 raw t ML-S r-ofL <br /> Thee undersigned hereby applies for permission to excavate,construc and/or otherwise encroach n County Hi hw <br /> sidesof �� �1 f approximately ty s Rr9ht-of- ay on <br /> of1040 <br /> Y / D l feamile XT <br /> by performing the following workdescri tion of <br /> ( p work). <br /> Work will commence on or about <br /> for approximately days. <br /> i,the undersigned,certify that(am the owner of the respective property, <br /> work described above in accordance with the rules and regulations of�Sa�n Jom qualified <br /> n Countyto represent the owner and agree to do the <br /> Joaquin and subject to inspection and approval. <br /> i Hato Pro `' ' 3 <br /> g re o Applicant•Title <br /> ate <br /> E.WU&SV WVMASTERPSkENCr4DACH NT PEFUT APPUrATx)N(XX jai," <br />