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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Oats 1 <br />To: San Joaquin Comm <br />aa�Pubk w«Ia <br />2 (1 (MPicarm )`` <br />7��J tP 1!7 i1G H. C/V"Y <br />(Mali ) 7 <br />(City, P Co&)�LC:. <br />Zoe Z1Z-�5'S <br />(Ana Co(h� - Telephone NwnW <br />(EmaO Addna) <br />JOUi <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />OFFlCE USE ONLY <br />730052 REFS <br />CRN <br />11 6 2023T0 5/6/2024 DRIVEWAYS: <br />Liber-tv Rd <br />Acampo QUAD <br />PQjgjjoplacement <br />SS W <br />Special Condifions <br />7petmwImaysuhmiUedj <br />QQ Al <br />F <br />V4 - <br />for <br />hr <br />rP_ pniLSSfnuba�aValef\el wn. isee <br />�ryHgn�nt-0 <br />amma <br />by pdomwg de �y7taym <br />wvlc (dewmption of work): <br />Work On commence on or after - for appromnatdy days <br />I, the undersTod, certRy that I am respective property, w am qua ffied to represent the owner and agree to do the <br />*v*deswited above in with and regulations of San Joaquin County and subject to inspection and approval <br />not -TWO • .Do% <br />