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:. APPLICATION FOR ENCROACHMI=Nu PERMIT <br />PLEASE PRINT: <br />pate 6 — ?`�' d�✓d•-V • . <br />!o; San Joaquin County <br />pepartin�ni of P'ub�lipc Works <br />(App[fewt Nara®) <br />i�oC5 r _ . ltfi%i�ti� f GT' <br />(NaifingAddrew) <br />�e� ION (rig 4q.15 ) 5 <br />(Csty, -State, Zip COOL) <br />/ao 91 u to Y - -8 I I <br />(Areaed=etepkfana <br />�, gsa�A <br />IOB <br />APN <br />EXP.DATR°9/15rz°z° <br />VALID <br />STRErl <br />OFFICE USE'DKY <br />730077 REFfr <br />CR,ur <br />6/972020 TO' .0 /15/2020-. DRIVEWAYS:' <br />Main St. <br />AREA <br />TYPE <br />Stockton QUAD ES <br />Bell Hole <br />FORMS <br />NOTES <br />SSNWV, R-29, Trench Cut Policy <br />Special Conditions •- <br />----EMERGENCY WORK'$*" <br />Thf�undersignedhereby appliesforpendissionfopxcavatt5,cqusfructaid(arafh0jVSeencroachoil Counfyfjigf, RightofWa in . <br />the l�[-�sidegf E M�ir�.�rl- appl4ximatety: fe mife <br />6ypedauuingifeiotl°wngWorlt escription0fwarfQ: <br />t(IlodEtvi([commanceonorabaut - -�O forapproxtnatEfydays.. <br />[, fheunde�stgned, cerfifythat l amthe owuerei`the respective properfy,ora<n qualified f° represenfifhe oWnerandagreeto du the- . . <br />vrar[idesci6ed hove irraccordauceivifhtiieeulesaridrequtationsd`rSan Joaquin Goun[yatidsn0jecffainspestiattandappravaf. <br />(� cw- <br />- <br />%natnro�f�9ppfr�a "kTr`4Pe <br />IICEmwIanNICE9CIEpc�3PJ4AV.WXtMSIEapS�U,'CRMC0.iIE7irPER41r(APPI1cA70N000 IU9�13J <br />h" <br />Date <br />n <br />