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a <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 1-31-14 1410-sq <br /> To: San Joaquin County-Highway Department OFFICE USE ONLY <br /> JOB# 7 _500S2- REF# <br /> PGll�nA E APN - - CRV# <br /> (Applicant Name) EXP.DATE, <br /> l5 Ze-t Nor+h Cr_rpf,n &SA VALID(/ 7 ¢ TO KZ 1114 DRIVEWAYS: <br /> (Mailing Address) STREET i, <br /> AREA E5 (o QUAD - <br /> Moctes-ty, , CA TYPE l( FORMS f5 w 2 <br /> (City, State,Zip Code) NOTE <br /> 269 - q 18-1328 (Ao-rbn LCt,,-4 crrmm <br /> (Area Code-Telephone Number) J- <br /> Sketch (Detailed plans may be submitted) --. ��-V_- C-civvo (e,+,c4 Aur, 4-p U,44n �I <br /> &PO <br /> lZo <br /> s� e <br /> 't-utie%'s�.�-r�—�r".v•r�r-cam Q-- 3 3 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway Right-of-Way on the 5�-h side of C,range AVe�oe. approximately <br /> y38 feet/mile W of 5e,tdner XQMe e.. , F�r_o ory , by performing the following <br /> work: (description of work): Ar 2A 113 O r const C- Ave no e- -f6r wor K cLJrecdy <br /> 02r-fb iA dive -6"Le ,IL <br /> a " yy i+-k �►a.s. Sere ice. �nsmoi- 1n W X 5 <br /> I elute- eyou Va+eA to a/c. &E-sWo elder PH 3105 oobs <br /> Work will commence on or about I 2 3- 2.014 for approximately I days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the <br /> owner agree to do the work described above in accordance with the rules, regulations of San Joaquin <br /> County and subject to inspection and approval. <br /> 0 ; Oa - ZO/y <br /> SI RE 01 DATE <br /> /N co nJJU N r-RCJ 1 B ! <br /> P/ Vic- c6AMID -. J044W �C� -SF' P(Lto6L <br />