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V <br /> Ob <br /> APPUCA,TION FOR ENCROACHEMEN I PER141T <br /> PLEASE PRINT: <br /> Date -7 _ OFFICE USE ONLY <br /> -10: San Joaquin County JOB# 3 00 5 2— REF# <br /> Department of Public Works APN CR# <br /> EXP.DATE <br /> VALID . TO _ _ DRIVEWAYS: <br /> X02 QCT, 1, TO <br /> Mame) STREE T <br /> Ito c lctvr AREA <br /> TYPE QUAD <br /> _ <br /> Falling Address) FORMS <br /> _ToRLOC ["44 3B0 NOTES <br /> (Curt State,Zip Code) -- — —— <br /> 7��i <br /> )Area Code-Telephone Mu€ ber) _ <br /> M L.LC-TV-<� �0— f�-TT. NE <br /> Sketch(Detailed pians may be submitted) <br /> Si✓E PrTTAGN�i� <br /> The undersigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highway Right-of-Way on <br /> the FASB— side of iN. ALS i,J� �,� <br /> of Atm?i,-D0 C approximately 40 feet/mile \,J ST- <br /> -QQDUA2—�oyn)o BSC t>JS _, by performing the following work(description of work): <br /> P(,� Pi�,Aa;2M St1VVICe o� or- t 4' PvC- G(�u► <br /> WOr1C Will commence on or about S -OS - S <br /> for approximately l days. <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 /> work described qOove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval <br /> 7 -- <br /> Signature of Applicant Title <br /> Date <br /> N410E I ISE 'CESICLERICAL'PUO-SV.WK4AASTErLP 1E7dCROACH;IE14TpFRG11TAPPUCAT101d000(2jq <br /> 1 <br />