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A-P t ER:A1'iON FOR ENCROACIIIA,NT PE1011T � <br /> PLEASE MUNI': <br /> OFFICE vs� ONLY/b/ �'O' JOB f{ 1M00 S REFt1 <br /> APN _ _ CRV# <br /> To; San Joaquin County I-Eghway Departrnent. EXP. DATE /0k—W17 <br /> VALID TO DRINrE WAYS: <br /> STREET Av(C � <br /> (Applicant:Name) AREA C. QUAD 6 k <br /> _ TY-PE_ Q r <br /> FORMS � <br /> (INtailin/g//Address) NOTE eX, rxrw eA en le <br /> IGT , 404 9r�'4 a� 7 - .-� <br /> i o 1' <br /> (City, State Zip Code) it o r r K�a� <br /> (Arca Codc -Telephone Number) <br /> Sketch(Det`Z plus-gay br subrnit;ed) <br /> i <br /> The undersiped hereby applies four p�err=ssion to excavate, construct and!or otherwise encroach on County <br /> Highway Rig -of Way on the �� --side of 4- approximately <br /> i� !miles oL of �.JAUP ) by Performuls3 t <br /> foilowmg work: (description of worn j: r^ ea <br /> Work will commence on or about for approximately days. <br /> I the undersigned certi�ihat I am the owner of the res'--c Eve property, or am qualified to mpresent the owner a <br /> agree to do the work described above in zcccrJance tivith the rules, regulations of Joaquin County and subs <br /> to inspection, a oval. <br /> i�IATU OF APPLICA N - =11: DATE <br />