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APPLE C� TION FORENCROACH PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date <br /> JOB # 1100 rS REF# , <br /> APN / 7/ - i,S2 - Z ff CRV# t <br /> To: San Joaquin County Highway Department. EXP. DATE -( G <br /> V,' LID TO DRIVEWAYS: <br /> _Starr O�s.�y STREET <br /> (APPlicant Name),.-- : AREA 9!.�iy QUAD._-.SS- <br /> - _ <br /> �w <br /> TYPEf Ta- _40 <br /> Z. <br /> /.3v w G oo�. g-yam FORUMS /-7 - <br /> Qdailing NO <br /> Address _ <br /> )__ ----_ TE.. <br /> (City, giate Zip Code) -- - <br /> (Area Code--Telephone Number) <br /> Sketch(Detailed plans may be submittiad.) _--- <br /> �9 <br /> The undersigned herebyapplies for <br /> pp permission to excavate, construct and/or otherwise encroach on County, <br /> Highway Right-of-Way - <br /> �h y Raht-of--Way on the�o r�fh side,of /.P,h�� ���=� �' " approximately <br /> feet /mile ofRT� R � ,�.(C�►. , by performing the <br /> ;( c <br /> following tivork:(description of work j <br /> W6ik wM commence on or about - - - _ =fora roximatel - <br /> -:.. _. <br /> _ _ <br /> PP yays <br /> Lthe undersi ed_ce ' ' <br /> �a rhfy that I am the owner of it e respective property, or AWqualified to represent the owner and <br /> a ee iv o the work described above in_ativith tike rules,regulations of San Joaquin C�`ounty and subject <br /> Br <br /> to inspection and approval. _ _ <br /> i <br /> SIGNA'I'fJItE OF APPLICAINT . <br /> a <br />