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J C 4�- <br /> Liu d J1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date J OFFICE USE ONLY <br /> To: San Joaquin County JOB# �,�'13 UU��—�� REF# <br /> Department of Public Works APN CR# <br /> /� _ EXP.DATE <br /> 4' !/(/&--S VALID —25--2 yTO DRIVEWAYS: <br /> (Applicant Name) STREET t ' <br /> // AREA �,p QUAD LQ <br /> TYPE Cv—�A P <br /> (Mailing Address) FORMS 2!3 <br /> �� NOTES <br /> (City, State,Zip Code) <br /> 20F S—/-7eq. ;Z-.36Z <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 2�1�i•1rG S <br /> 5 i�,3 -73 Z 3 <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> theN&Jb side of — DODBC-46,1- R-d approximately z/22—r e mile GEST <br /> of /��i✓iy�P/C,� /Z/> Ssf�,S '()A-&W Af ter,. . , by performing the following work(description of work): <br /> r— <br /> /ftp //US 74 <br /> 'Mork will commence on or about for approximately a days. <br /> I, the undersigned,certify that I am the own r of the respective property, or am qualified to represent the owner and agree to do the <br /> work described above in accor ith the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> y <br /> Ae o pp' t-Title Date <br /> M ICEHTR4SERVICESICLEMGAL'.PUBSV WKIMASTER PSIENCP.OACRMENT PERMIT APPLICATION DOC X9113) <br />