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APPLi C T!ON FOR ENCROACHIMERPER [ <br /> TT <br /> PLEASE PRINT: <br /> - -------OFFICE USE ONLYDzite 4- -- -- <br /> JOB # REF# <br /> APN = - CRV# <br /> To: San Joaquin County ITighway Department. EXP. DATE Qpe�G 3 a <br /> VALID A/ —TO DRIVEWAYS: <br /> �' ATFT ,BEY/rt/ LOQEiVZ/iV/ STREETlP* ,/s/Ly <br /> (APPlicant Name) AREA <br /> TYPE__;To/� <br /> 14:�� til,'11iI�1Q/lET BG!/D s'TE 9 <br /> FORMS s s/uj <br /> _(Mailing Address) <br /> NOTE <br /> (City, State Zip Code) <br /> 9/l0 - 92g -DB4-3 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be Submitted <br /> W_5'z�B _ATT4e1-1E,6 DQdW/Ne <br /> - r-: Bio <br /> -7 y q <br /> a..� <br /> 77 <br /> r_ • �y-n. <br /> The undersigned herebyapplies for --_ - <br /> pp percussion to excavate; construct and!or otherwise encroach.on County. <br /> F.ighway Right-of-Way on the W6ES7_ sided .DA-V/s'20,1 UA/02TH's%�E TC/P.UEC�approxim° telt' <br /> 75" feet /mile_ of b mung <br /> Y perfo ' � the <br /> following work:(description of-work): PL,4eF -2-.- MWIVMOZefS 4ND` L"ONAVFe7 W 17 <br /> /70-1--ZE7 G r,11,o WMe T/I�Nc'y- WITH 4" /14ULT/G'EL L'D.VDU/T; <br /> 77:7- <br /> Work* commence on or about____AP,IZ/L f`7-, !9,95 --__-- ---for a rmimatet -_--/-0 da <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the.�vork descnt�ed above in accordgnce with the rules;regulations of��.n.lo;rquin C';ounfy and subject <br /> to inspection and approval. <br /> _S,.I-�G;N- AT.�U...R---E-_OF APPLaIC <br /> ANT-"_ <br /> - DATE <br /> ; � _ _ <br />