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Ps �so71�81 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEAS— E----PRINT: <br /> Date <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB# 7�I'� REF# <br /> APN <br /> EXP.DATE 3 S� cR# <br /> (Applicant Name VALID 0 IS <br /> STREET 0 DRIVEWAYS: <br /> � 5 Ch ve � Soo ��' AIA QUAD <br /> �f(Mailing Address) TYPE <br /> � <br /> Y/ t sR 0 NOTES <br /> Ca- °� 3 7a-� <br /> (City,State,Zip Code) <br /> �--�Gt —3 93 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> Sc�, �"04q,,t.,, <br /> - Plat#Zqg (k C�b� <br /> Pale-h Ae�cA-bLn <br /> `7r�+1rk p�ac�a 0 �{- I"�" cE�ct��#- -IYo•►� ell,)-pale-a k7&jcQ <br /> —Tr -t* + p lose. 2z-f+. I—Ll c (tt,— S4T -t Aeo V R>*b abl�; <br /> bore ; <br /> (71 c RSVe ( r rt e,, e31— <br /> c 5 tj <br /> The undersigned hereby applies for permission to excavate, on X77 <br /> the side of construct and/or otherwise encroach on County HighwaRiht Way on <br /> Of approximately Highway <br /> by performing the followi feet/mile <br /> ng work(description of work): <br /> Work will Commence on Dr about�3 <br /> for approximately <br /> 1,the undersigned,certify that I am the owner of the re days. <br /> work described abov in accordance with sruu a property,or am qualified to re <br /> the rules and regulations of San Joaquin CountyId subjeesentct <br /> the owner and agree to do the <br /> and subject to inspection and approval. <br /> Sign a of Applicant-Tide6 !„ <br /> E W-U SV VM W'°'"s <br /> i <br />