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APPLICATION FOR ENCR DACHA {: T PEI UT <br /> PLEASE MEN']': <br /> �orr�cE USE ONLY <br /> Date /Q- /'�- ?_rTOB !1 b C) REFti <br /> APN - - CRV#/4d' ) <br /> To: San Joaquin County Highway Department. E,P,DATE 3o yo <br /> VALID TO DRIVEWAYS: <br /> _C7 ,L4&et E�s/�iC Z��. STREET ✓4,eio vs Ro� �.¢rTAc.�/C,b <br /> (Applicant Name) AREA QUAD ,, cv � <br /> TYPE4'reoxWs - <br /> �. _2Q,lG_T`a 9 FORMS S5; w wa Nf3, <br /> (iNZailing Address) NOTE <br /> AA1_,V«T �rav6_ �.¢. VS <br /> (City, State tip Code) <br /> ql& - 77 6 —3 9,5-3 <br /> (Area Code -Telephone Number) <br /> Sketch(Detailed plans mw,br submitted) <br /> A,f7 CU e i41 <br /> (jw� �'y�o fa/id,c�2 f ECEslJ�2 �•�C%�'Q•4 Chi m�N� •Lo c�..o-fia,cJ,T /�i-/i`T4.� <br /> .ZN <br /> The undersigned hereby applies for permission to excavate constmct and/or otherwise encroach on County <br /> .57-,Qas <br /> B ghway Right-of-Way on the —side of,/,4A A111r .,&a11E Gia"SG2A Meg ejg s approximately <br /> U,a2iok ,- feet /mile !//I,eio� of 477_,10Ae� '09�4A7- , by performing t <br /> following-,vork: (description of Work): ,c '"a. a o N <br /> lv ,c_,4e_6 i` o 2EG�Ei .41_0,,1YV I-S <br /> .,"d-. iii <br /> LCE ern �0l� /F /-cc <br /> elf <br /> Work--.NU commence on or about / for approximately 0 days. <br /> I the undersimed certify th:,t I am the owner of the.res-ctive property, or am qualif ed to represent the.owner 2 <br /> agree to do Cbe%vorlc described above in accordance wida the rules, regulations of Swa Joaquin County and subj <br /> to inspection and approval. <br /> SIGNATURE OF APPLICANT - TITLE DATE <br />