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. ..�.. -....�. � . ,.iwi � , vu.v...� i nn IYV, .c�i7V0'+v_i17.: I'i�.f-. GC• L'v_w_r� 1v!.`,!H':' I- � <br /> APPLICATION FOR ENCROACMMgT PERMIT <br /> Date OFFICE ME ONLY <br /> To: San. Joaquin county JOS $�,34 p�'� � <br /> Department of Public _Works AFS CL' � <br /> �, s .. qz6p�C 20daDVIVEWAYS <br /> {APpliaaat Name) STMT _w iw.A&-4- AMS ,r <br /> QUAD <br /> TYPE 11,011 <br /> t�# * .._. <br /> Mailing Address) FORMS <br /> - 4'h NOS <br /> (City, slbate, .Zip coact) ; <br /> 1A61A I r e <br /> (Area. Code - Telephone mer) <br /> Sketch (Detailed ail=s May be 3vk itted) , <br /> ' r INV <br /> The undersigned hereby applie <br /> otherwise-encroach, s for Permission to.excavate, cOnstruct and/or <br /> oaz � <br /> ouaty•8a.ghway Right-of-�7ay~••on-the •' ' •• si+ele of,... ',' <br /> of -- �, approximately <br /> followize work ((lescription of;work) .� by'y oxmi..Yfg the N` <br /> u - <br /> b�' VIM <br /> Work will commenceoa or, <br /> days about C1 'dla"C1 for approximately <br /> . . , <br /> I, the =dersigned certify. that r am the owner of,the respective-property, or am <br /> qualified to represent the owner and-agree to do the ikrk described above in <br /> accordaxice with the rule , regulati of San Joaqu Covaty and sub <br /> —spect:.ox� a>�a ar4va i. os-as L.cY�lY 'ecto <br /> Signator© of applicant - Txtle <br /> Daae <br /> �sx�x.pi�rnsc� ca�oo� ,• ,.. , . <br />