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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date g'y-Z-I <br />To. San Joaquin County <br />Department of Public Works <br />(Applicant Name) <br />L r' J/I 5-,//t 1. T - <br />(Mailing Adti�r ss) <br />�-nci i�•{�i U/.a �S2ab <br />(City, State, Lip Code) <br />(Area Code -Telephone Number) <br />(Email Address) <br />JOB# <br />730052 REF# <br /># <br />APN <br />Exp. DATE DRIVEWAYS: $/6/2021 TO 2/15/2022 <br />STREET Section Avp ES <br />AREA Stkn QUAD <br />TYPE IVP\A/ Polp <br />FARMS SSfWVV <br />NOTES Snpr.21r dt s <br />;d plans m tie submitted) �f <br />J <br />,i <br />C(- <br />1-1 -7 47 ` <br />The undersigned hereby applies for rmiss on to ezca construct andlor otherwise encroach on County Highway Right -of -Way on <br />side of appmximawy It7 rfee�mile�_ <br />the <br />I o� L.:3eAz �_— by performing the following work (description of work): <br />Work will commence on Drafter <br />k ro orappm)dmtiy I RZ5 days <br />I, the undersigned, certify that I am the c of the respective property, or am qualilied to represent the owner and agree to do the <br />work described above in acro a withthe rules d regulations of San Joaquin County and s1kject to inspection and approval. <br />Date <br />a-747 <br />The undersigned hereby applies for rmiss on to ezca construct andlor otherwise encroach on County Highway Right -of -Way on <br />side of appmximawy It7 rfee�mile�_ <br />the <br />I o� L.:3eAz �_— by performing the following work (description of work): <br />Work will commence on Drafter <br />k ro orappm)dmtiy I RZ5 days <br />I, the undersigned, certify that I am the c of the respective property, or am qualilied to represent the owner and agree to do the <br />work described above in acro a withthe rules d regulations of San Joaquin County and s1kject to inspection and approval. <br />Date <br />