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May 17 13 08:45a Woodbridge Fire District 12093694568 p.2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3 OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN GR# <br /> EXP.DATE /3 <br /> VALIDS' T /3 DRIVEWAYS: <br /> -� (Applicant Name) STREET <br /> AREA A ,JQ'Pe-Q1AAIW <br /> D <br /> TYPE 391111?J1� <br /> (Mailing Address) FORMS <br /> , NOTES <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> R � ; <br /> 41 <br /> r' J <br /> 1 4 <br /> r a <br /> i <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right-of-Way on <br /> side of r�= r,;, ¢.�:' '_���:� ,��:~,. � approximately �—�'"° 'mile <br /> of F by performing the folfowin g work(description of.work): <br /> 1.3 <br /> Work will commence on or about 1�')��,i �� `�r�x��—for approximatelydam <br /> I, the undersigned,certify that I am the own erof the respective property,or am qualified to represent the owner and agree to do the <br /> t�vork described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> i f3 <br /> Signature of Applicant-Title Date <br /> ESP;�S''4.WHRV.STS.PSiENCP.O4CHLENTPERMTl.PPIICRTIQI.DOC (:1rOS) <br />