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APPOCATION FOR ENCROAC AIN'T FE&MIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date /D-Z-9S JOB 0 73 0.5-1 REFH <br /> APN <br /> To: San Joaquin County Highway Department. EXP. DATE47-_31, G DRIVEWAYS: <br /> AREA G in��Gi✓ ,vE <br /> CONTEL OF CALIFORNIA TYPE <br /> (Applicant Name) FORS 1S 5 5/urt•J,/2-z y = <br /> q30 W. CEI/TE_k ST, <br /> NOTE <br /> (1%Sailing Address) <br /> MANTECA, CA. 95336 <br /> (City, State Zip Code) <br /> C2o5 ) -7 3Saz6S <br /> (.Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted): <br /> �e IIV7 <br /> �GJ <br /> 1.e'1 <br /> C� U <br /> The undersigned hereby applies for permission to excavate, construct and r or otherwise encroach on County <br /> L;ighway Right-of-Wav on the e--,q 57- side of /nuZ2Y e0A-f, <br /> &"E0:ile of �PQOn9 yNGO �ZG , a0 v Tf/ ,/O/Z f j , by PerfoI�lII$ the <br /> following work: (description of work): &v,ey__ 7�L��,�o�✓� G�-13G� moo" O � � <br /> _5-'0a EDGE �2Dvz�c s�z✓�C� <br /> "9- A/'EJ /� 7V(f-- CJ)A)D&,e ocTio n/ <br /> Work will commence on or about --o - is- 5S for approximately S days. <br /> I the undersismed certifv that I am the owner of the respective property, or am qualif ed to represent the owner ant <br /> agree to do the work described above in accordance with the rules, regulations of San Joaquin County and sublet* <br /> to inspection and approval. <br /> OSP eTiG, �� /D- Z - 9S <br /> 7,-g E OF a.PPLI..'N- 7 - TITLE DATEE <br />