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X�002. <br /> and�qt, <br /> a�- <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> 1I��11� OFFICE USE ONLY <br /> rl <br /> JOB# �: ZZ �F123 REF# <br /> To: San Joaquin County APN CR# <br /> Department of Public Works <br /> EXP.DATE <br /> _`_�L DRIVEWAYS: <br /> n Jk('V v�rn Coy�sv���hA VALID l� <br /> (Applicant Name)J STREET ik.V <br /> AREA osVV—% v`QUAD <br /> oLtM TYPE <br /> (Mailing Address) FORMS r <br /> NOTES <br /> uJQ�k SWLX&VAtV�o ItA IkEOI <br /> (City,State,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> ri pd <br /> 5 <br /> C(1 <br /> ter,tv <br /> ZQIC-22'7 <br /> STR� N1U VJa ROUTE NO.a <br /> The undersigned hereby applies for permission to excav te,construct and/or otherwise encroach on County Highway Ri ht-of-Wa on <br /> a�.r. approximately 1.2.k fee ile AS <br /> the E0.Sk side of ..�...VrYY1a 8.00. <br /> Of Q t (AIL101mra by performing the following work(description of work): <br /> CI Will i a>n S vY1 lG 2 eX lora 1 de ow tyl . <br /> C,, �-1�'` 'avhe l' to s�twt qtr • � � � � ++aln, ut'h <br /> CAr Mo l o 'h to <br /> VOL QCS Wi 1 � it lr�,�6e' its CYF <br /> f W• .Q 2 p bDY1h -f0 <br /> 3 W� � e Q <br /> days. <br /> Wo will commence on or about 2� r approximately 1 <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> worts described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> 23114 <br /> Signat a of Appii ant.Title Date <br /> M10ENTRALSERVICESICLERICAL.PUBSV.WKWASTER.PSIENCROACHMENT PERMIT APPLICATION.DOC (09/13) <br />