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` PLICATION <br /> 0— -- - - - -, - 31Z- <br /> AP <br /> -�/ Z- <br /> �a P t L I t.ATIOi� FOR ENCROACH,),* PERII�TIT <br /> PLEASE MUNI': <br /> OFFICE USE ONLY <br /> Date 9)2 7,/�S- JOB # REFf# <br /> APN 11,3_ - is D - O/ CRV# Z <br /> To: San Joaquin County I-Echway Departuaent. EXP. DATE ill <br /> VALID /7 ,w S— TO / DRIVEWAYS: <br /> �t 1 AIV U Fz ��i ,v c� z STREET au — <br /> (Applicant Name) AREA ZP6 7 QUAD r—c- _ <br /> ' , TY ��r�fe- <br /> -PE_ <br /> (ZJ �;( s•��., (�s t3 <br /> M,33 vi ZVd`4 4 2 S'fi Fop-NIS S' <br /> (INIa ng Address) NOTE <br /> (City, State Zip Cotte) <br /> 464- i 271 <br /> (Area Code -Telephone Number) <br /> Sketch(Detailed plans -ray 1 r subrrit:e(!) <br /> r� <br /> �Caud1112yDOU— <br /> The undersigned hereby applies for permission to excavate, construct and!or otherwise encroach on County <br /> g;ghway R i aht-of- ay on the N A-5 side of C'ou I4Fg C t u b U v I vC �.e).S Jit+ss �y approximately <br /> Feet, /mile of , by performing t <br /> following work: (description of work): 5o-d 1Wv1` 15 u ems• v-') W-vv`- , Ob <br /> 'Zi� <br /> Work-»-ill commence on or about 06TV 3 c2 26 for approximately_—_days. <br /> I the undersi=ed certif''hat I am the owner of the.res-ctive property, oram m qualif ed to represent the owner a <br /> agree to Jo ille work Described -1 in accorJancc tivith the rules, regulations of Snit Joaquin County and subj <br /> to inspect • and approval- <br /> -7. IFIt, <br /> S i�ATURE OF APPLICANT - TITLE DATE <br />