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APPLICATION FOR <br />ENCROACHMENT PEROT <br />Oft (�/ � " 73 <br />OfFICE USE ONLY <br />To: San Josquen C" <br />a <br />730052REF s -- <br />Department of aibc w� <br />t APN PN <br />CRI <br />POE <br />EXP -DATE <br />------ <br />VALID <br />7/1/2023 TO 1/112024 <br />(APPtiaM48me) <br />STREET <br />Brennan Rrl <br />AREA <br />ESGalnn CAM CF <br />3139 t3oemQ Way <br />TYPE <br />^ -- a I VVio rk <br />(Mailing Address) <br />FORMS <br />SSAMN <br />NOTES <br />Stockton Ca. 95206 <br />(City, State, Tip Code) <br />r <br />(408) 316.1767 <br />(Area Code • Telephone Number) <br />STDwPGEPenTdfs@Me.com <br />(Email Address) <br />;7' <br />ch ns be su¢mitled) <br />7 �v <br />r / <br />vr�iy <br />e� <br />9— <br />17 <br />OM"AYS: <br />The undersjgned hereby applies forrmission to excal � e nstruct and/or otherwise encroach on County highway ngMof-why on <br />the 5 side of �eNye � / approximately �� Qfee l0mile moi_ <br />of q Jenz-S r . by performing the following work (description of work): <br />L1 <br />Work will commence on or after -7—(— for approximately leo 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 acco r1 e les and regulations of San Joaquin County and subject to inspection and approval. <br />Si ant • Title Date <br />