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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date �� i7 OFFK <br />To: San Joaquin County <br />JOB # <br />Department of Public Works <br />APN <br />�' n <br />EXP. DATE <br />(($I�fa <br />'�( l tiv� <br />VALID <br />(Applicant me) <br />STREET <br />Yt 1��3$ <br />AREA <br />TYPE <br />(Mailing Address) <br />FORMS <br />JJ ^& q" <br />NOTES <br />r <br />(Ctty, State, Zip Code) <br />(Area 6 O - Tele hone Number) <br />y_tl7c m fl <br />V < (Em <br />it Addr ss) <br />t'ch (Detailedplans may be submitted) <br />�9 f <br />The undersigned hereby a <br />the Noy -1 L _ side <br />of A lzw, q '6%�anrpn <br />will commence on or after <br />CVbss plc 'ik) <br />110005 REF# <br />CR # <br />2/28/2024 TO 5/28/2024 DRIVEWAYS: <br />Eight Mile Rd <br />Stockton QUAD <br />Trench (Dirt Shoulder) <br />SSANW. R-29 <br />Conditions <br />excavate, construct and/or otherwise encroach oy County Highwa Right -of -Way on <br />approximately q2 ee ile_kAVA- <br />- by perform/ g the following work as <br />iption of work): <br />a <br />for approximately days. <br />%that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br />accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Date <br />i <br />