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APPUCATM COCA ENCROACHMENT PEGS IA u <br /> PLL- ASE- PRIN V e <br /> Date _ -� � � �,� — OFFICE USE ONLY <br /> To: San Joaquin County JOS# 52-� REF I <br /> Department of Public Wori(s APN <br /> pg CI�_ <br /> Ll O Q B EXP.BATE - _ — <br /> VALID <br /> QA�pGuoaro �Ga .e� STREET TO DRIVEWAYS: <br /> AR �.rr , ZED. t <br /> --!-//,0 '�� �� �� 1G�� I�YPE REA7'11 t4 QUAD <br /> - � __.— „ <br /> E1 <br /> (Gtt9aflingAdldress) FORMS <br /> 1< A NOTES <br /> PlY, aice,Zip Code) — -- <br /> (Area Code d ece�vF��rue�u�� G�cP� - <br /> Sketch (Detailed plans may be submitted) -- <br /> Tee undersigned <br /> igned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of Way on <br /> � side of �-P✓rG _ —�`a.r p�h.r�t dppro>cimately J 6� <br /> of �^1 a �-c p d S� - ® by performing the fell©wing work escriptiort of-- vorlc): <br /> _for approximately days <br /> I, fihe undersigned,certify that i am the owner of the respective property,or am qualir ed to represent the owner and agree to do the <br /> work described above in accordance with Te rules and regulations of San Joaquin County and subject to inspection and approval. <br /> �0,1AAa 6 )a,-j4 <br /> AtIC[t'iPJiL;.ERUw�51CLERIC.LIEU&SV,}i'KL'/fiS7ER PSIQ:CROACHtF[NT PERI�;[gPPLICRl10I1,00C(0?!13] <br />