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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Daw -If-23 <br />To: San Joapua Cotalty <br />rrt of Pub5t WAS <br />(APPS Nww) <br />fqpncAwS ial <br />(M in ddren) <br />_} Gut 4 SLQ(. <br />(may. Stab, Zip Code) <br />-_ 2742 V,,., 53 <br />(gym Coda • T <br />Pfd P A� G�Lg•cw+ <br />MAIM Addraas) <br />JOa g <br />APN <br />D(P. DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFICE USE ONLY <br />730052 REF g <br />CRO <br />8/1/2023 To 2/1/2024 DRNEWAYS <br />Santa Fe Rd. <br />Escalon ()UkD SE ' <br />F3) Pole Replacements <br />SSMAN <br />Special Conditions <br />n <br />Sketch (Derailed dans may be submW) P� <br />X j <br />ir <br />io r L <br />The t>erebY aPPf i� construct and/or otherwise enaaedt m Corer High �p�.�t or <br />the side of S4�r approximately } S 3 7 -5 r <br />of DYcr. b��CSc m <br />by Pe+�t9 the tolowitp work (desaipticn of work): <br />/ ✓ ce i Gilkr i 1, c� <br />5( <br />Work will commence on or Wier — — for approximately days <br />woo k undersigned, above <br />in that I� respective property, or am qualfied to represent the owner and agree to do the <br />work described above in ace( wdh and reguWons of San Joaquin County and subject to kWeciion and approval. <br />DO <br />