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APR-19-2813 11:58 From:12898391796 Pa9e:1-,"2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To, San Joaquin County JOB# RE!`# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALIDT » DRIVEWAYS- <br /> 3 1 <br /> (Applicant Name) STREET S wJ zD1 <br /> I� QUAD <br /> TYPE <br /> (Mailing ress) FORMS 3Vwld ,LS <br /> NOTES <br /> ( e,Zip Code) <br /> aha -z7a, o 9-� <br /> (Area Code(-Telephone Number) <br /> Sketch(Detailed plans may be submitted) �� <br /> AC,947 <br /> The undersi ned hereby applies for permission to excavate,constr ct and/or otherwise encroach on County Highwa Fight-of-Way on <br /> the side of .A 0 Q S. �(Mso�l approximately ee ile <br /> of ,by performing th following work scrip" n of ork <br /> Work will commence on or about r for approximately days, <br /> f,the undersigned,certify that I am the owner of t 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 /> Signature of Applicant-Title Date <br /> EVus-SV.WKI TER.P$�ENCP AemmENTPEPMTAPPLICATFMaoc(008) <br />