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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT. <br />Data <br />To_ San Joaquin county <br />Deparbnerrt d Pubic Works <br />JJ (Apptkard Na/me) _...— <br />�) lxl ra�Jit'.i�t C �+ <br />(MaiM Addrss <br />(City, State, Zip Cods) <br />y�r 3/(.-y7 7 <br />(Area Code - Tele ce Number) <br />sn-V . bs ��(.-t cam.. <br />(Emall Address) <br />JW a <br />APN <br />I EXP DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />OFFICE USE ONLY <br />730052 REF a <br />CR R <br />9/1/2024 DRNEWAYS: <br />Mourfield Ave. <br />Stockton QW <br />Repair Ground Wre <br />FORMS <br />NOTES <br />SSAA r <br />Special Conditions <br />Sketch (DeWW plans may be submli <br />9- Z <br />s 41e_la d✓f <br />The unders" hereby applies forpemZon to excavate, conshuct andlor otherwise encroach on County Highw y Right -of -Way <br />the side of o� cls approximately f) c� /nyto <br />of6ti�— PV by performing the following work (description of work): <br />-74-3 ✓Cj3-*,i a w:r^1 w. le <br />Work witi commence on or after -1- 2 for approximately days. <br />1, the undersigned, certify that I am the owner of ft respective property, or am qualified to represent the owner and agree to do the <br />work described above in aco?�aaeo-witlrlh�ndes and regulations of San Joaquin County and subject to inspection and approval. <br />2el <br />Date <br />... <br />