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APPUGATM FOR-EINCROACHWEENT PERNU <br /> PLEASE PRINT: DEC2015 D —2 Al" 9: f <br /> Date 1 r 1 I l I OFFICE ONLY: c . ui <br /> 10: San Joaquin County JOB# x .` (,f- �) S REF# <br /> Department of Public Works APN <br /> OR# <br /> EXP.DATE <br /> VALID TO J —( — f DRIVEWAYS: <br /> (Applicant Marhe) STREET _ <br /> Lla., AREA QUAD <br /> �1 /��<<' Vifta,� TYPE <br /> (Failing Address) FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> t-LIC) <br /> (,�j <br /> (Area 'ode-Telephone Mu.mber) <br /> Sketch(Detailed plans may be submitted) <br /> �`` f G"` 1 ` 'VV:�r`'•�..\ Y� f3L� <br /> The undersigned hereby applies for perrnission to excavate,construct and(or otherwise encroach on County Highw dight-oi'JJay oil <br /> the ° z�n �� side of I j,� >`i �>c L 1 7/',� e r <br /> —1 c� c f�3pproximately A L> ��yy <br /> of �,��� b . _ .1 �ee/mi[e `0- <br /> ,� i_ E by performing the following work(description of work): <br /> t 7 J E C' [,2 e <br /> Worlcvt�iil commence on orabouf_11T Le.�6:=,�- `)[1.���-" forapproximate[y��°� �,,.EL„ I����, - �l .�„a days. <br /> I,the undersigned, certify That 1 am the owner of the respective property,or am qualified to represent the owner and agree to do the- <br /> n County and subject to inspection and approval. <br /> Signature of Applicant Title <br /> Date <br /> F/'1CENiiLtSMICEaCBICALIPD&SV.WKV;,ASTE2PSM”CROACH;7EFITPEFh11TAPPLJCAi70kDOC(0?q <br /> 1 <br />