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Dec 11 13 12:23p Independent Irrigation Sy 209-358-0687 p.2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOB# PUJP lk L__>5� REF# <br /> DeparlIment of Public Works APN CR <br /> _ EXP.DATE Z-- <br /> p�.,cl,�.;i Fd-rJi: �lit'il rV�7P1 S »c VALID k-27- 2e)gTo 2—t—Zoty DRIVEWAYS: <br /> (Ap licant Na e) STREET M0.1ti01\- <br /> AREA tip-. QUAD .SE. <br /> TYPE <br /> (Mailing Address) FORMS <br /> / NOTES <br /> _�ii'✓J, ! cjt�/7 , �9, 9-5--3 3 <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> 9 - _9_6L__062 7G- - <br /> Sketch(Detailed plans may be submitted) <br /> I� /1144oe Ao.ed,a�J,%P <br /> n l �Si J � Lsta,EY��i/ <br /> �e <br /> i <br /> 0 <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highamile <br /> Right-of-Way on <br /> �_ A.I L� sideV C'�/Q h 0i3 Rek:s approximately �� ,rte;c i' <br /> of SrGleh ii�1 , zEa-,a by performing thefollowing work(description}of work): <br /> 130 i O r h iG%l 4 /S� .i� _(�✓� f�r %�1 c�,n T� i c h S gni <br /> Work will commence on or about /— - for approximately days. <br /> I,the undersigned,certify that I arae owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work described above in acro a Wth the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> M.'ICFNr"kgFT CE=LMICALWU&SK'-MMAgTEA.PS'E'('R=HM3JTPERUTAPPLICATIDkDCC IC71131 <br />