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-1, <br />APPLICATION FOR <br />PLEASE PRINT: <br />Date <br />To: San Joaquin County <br />Department of Public Works <br />hWiZErox-ZnAm <br />(App cant Name) <br />(Balling Address) <br />k k k <br />(Area Code a Telephone Number) <br />(Email A dress <br />Sketch (Detailed plans may be submitted) <br />ENCROACHMENT <br />1 42P <br />PERMIT <br />JOE <br />APN <br />EXP.DATE <br />VALID127 <br />STREET,¢k�LL1I <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE. ONLY -- - -- - <br />!/DDC REF # <br />CR #� <br />S ► ya <br />Za TQ i z# DRIVEWAYS: <br />° <br />QUAD 5&,1 <br />tre_A.?r't. m 7.1�✓tcES <br />�✓ gal <br />SF�c�A� ,c�DrrraUS'' <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highwav Right -of -Way on <br />the y{ _ sideSf _ E ,r � � approximately ?esc <br />mile � <br />of : :-!:AQP �, by perforniing fhe followinIt-g workrlptlon of wark): <br />Work will commence on or after _ for approximately go —days. <br />I, the undersigned, certify that I am the owner of the 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 />�CA - �w - �Powq- (�XKVV&T� 11 - <br />kk 104at <br />Y VORW %TELJP ATESW4M WOHWJ1TP0W 7WRlU11011 OX 100.0!1 <br />