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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date — <br /> OFFICE USE ONLY <br /> S1 I C'; <br /> To: San Joaquin County JOB# 7 REF# <br /> De*pallenPublic Wo s APN CR# <br /> EXP.DATE IJ - 1 - 15 <br /> VALIDO- $ TO ( � _ _ S DRIVEWAYS:licarr ) STP,ELT ✓ave l��p� 2i{ <br /> s AREA /� QUAD <br /> "" ✓ ` TYPE <br /> ( ailingAddr ss) FORMS SSls� 1\ Z� <br /> C �} NOTES <br /> (City,State,Zip Code) / <br /> 311. .532 <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> WV ,�ej <br /> 1C) -�oi <br /> The undersigned hereby applies for permission to excavate,co struct and/or otherwise encroac' o Counfy Highw Right-of--Way on <br /> the f^� side of_� � 1��� <br /> of ►i--- approximately 2 <br /> (' j 17iD fe mile <br /> by performing the following work escriptlon of worts): <br /> 1111, <br /> Work will commence on or about — <br /> for approximately 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 above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> PreofApplicant-Title S <br /> I?ate <br /> 4f1Ci�R(iF1S�FJG"cfLLXCRIC'%d'F{:H-SV VJI'.1!i.:STEP.(-4FJ•Y_'F.CCEII.�lff f'ER'.1R AEi�:1GiT1IXJ;;pC �L'-`/i:)) <br />