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A-P.MfATION FOR ENCR.OACI I) . T PE1011T � <br /> v' <br /> PLEASE PRENT: <br /> OFFICE USE ONLY <br /> Date JOB ii1 3-o 9-0 REFti <br /> APN - - CRV# <br /> To: San Joaquin County Highway Department. F-s[P, DATE,.--'a,/'5 q s- <br /> r � G NAYS:/ 1 . 7 <br /> STRL-ET <br /> r1 licant Name <br /> (Applicant } AREA �oV? QUAD NecJ s <br /> TYPE �-,Cevc.•.� # <br /> FORMS <br /> (I Luling Address) NOTE <br /> (City, State Zip Code) <br /> 020 F - y73 - <br /> (Arca Code -Telephone Number) <br /> Sketch(Detailed pians may br subm..itted) <br /> o m <br /> rT; Cn :n <br /> A <br /> co-) �= <br /> ry�' C-) .7 <br /> a :c m <br /> n r < <br /> ZE C> rn <br /> _. r <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> P ighway Richt-of-Way on the Geos side of approximntely <br /> feet /- e-�l� of , by performing l <br /> followingtivork: i ae gip of titi�onc): <br /> Work will continence on or about l/>— for approximately� days. <br /> I the undersigned certify that I am the owner of the.res-clive property, or am qualified to represent the owner e <br /> agree to do Lho work desenbed above m accordance .vit.h the nules, regulations of San Joaquin County and subj <br /> to ins tion and approval. <br /> SIGNATURE OF APPLICANT - =E DATE <br />