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APRJCA7nON FOR ENCROACRAW PERMT <br /> PLEASE PRINT <br /> Date OFFICE USE ONLY <br /> To San Joaquin County JOB# 1 Q REF# <br /> Department of Public Wo*s APN CR# <br /> EXP.DATE <br /> VAUD A0 T I I 13 DRIVEWAYS: <br /> (Applicant' <br /> AREA <br /> QLAD A <br /> TYPE <br /> (Wiling Address) FCRvIS <br /> NOTES <br /> (City,State,Zlp,Code) <br /> -Tel <br /> rj 1 L�(Arlea CZ& <br /> Sketch(Detailed plansnmy be subrritted) <br /> The undersigned hereby applies for permssicn to e"e,construct ardor otherwise encroach on Ca M Hghvay Rght-d-Way on <br /> theLLZ4� sideof —appro)dm3tely a olp feetIrrile <br /> Of <br /> byperbiiing the fdlO\Mrlg VIAXk(description of work): <br /> Work will conTrenoe on or about. 43 &,P for approximately <br /> _days. <br /> 1,the undersigned,certify that I am the amier of the respective property,or am qualified to represent the omw 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 /> 4 �icart�-T(de 7-- 13 <br /> - <br /> Date <br />