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' ' APPLICATION FOR ENCROACHMENT PERMIT <br />P�EA��p1�IN5`: <br />Data20 19 <br />To: San Joaquin Coulrfy <br />Departm ent of Public Works <br />CtP�f A V�JWWrEp 6 60, 10, E <br />(Applicant Nartro) <br />• (Mailing ddressJ J <br />522 afikadn,� <br />(city, State, Zip Code) <br />/ao�l co'Y <br />{Avea Cade�Telephone Number) <br />OFFICE USE ONLY <br />JOB#pp <br />1% REF9 <br />APN <br />-, <br />_ CR# <br />EXP. DATE <br />r f <br />VALIDQj119 <br />T • 'v ti" ' DRIVEWAY& <br />8REiiT <br />6 <br />A REA <br />SToa cn..J QUAD AM ` <br />TYPE <br />o<6 { <br />FORMS <br />wW dt-Zy 1e is <br />NOTES <br />M4 <br />Thaunderstgnedherebyappliesforpenriissionfoexcavata,cgnsiructaudlgrotherwiseencreach,onCowtyl•ligh RighY�of-Way on . <br />the sjdeof Cd rout approximately , ) 5 $ e lie I <br />°f +��1 F by porformtng thefollewing work (esc iption of work): <br />Wod<wifl commence on orabout � X019 forapproximately days. . <br />t, tha undersigned, certify that I am the owner of the raspWive property, oram qualified to representiho owner and agree to da the" <br />wont described abomfia accordance with the rules ondregufations of San Joaquin Eeuntyand subject to inspection and approval. <br />llcFxµWaER7aESFIHilcAVilnavwnvA4siE4rslqitaoµ'µuBRPflwl(PkYllannat000 pd��) <br />II�19-�019� <br />