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e cam: _-ori �ri•�'�4.�bt�yJ PAGE 02103 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASi:PRINT; <br /> Date Q Q OFFICE USE ONLY <br /> To; San Joaquin County JOB# //f] REF# <br /> 7epartment of Public Works j APN CR# <br /> f� EXP,DATE r O <br /> �Q�� t4 VALID 61 TO _ t ,01 DRIVEWAYS; i <br /> (Applicant Name) STREET u <br /> AREA QUAIL_ <br /> TYPE 14� <br /> (Mailing Address) FORMS 51; l✓w' <br /> NOTES <br /> S-�'4e-Vtd I- I (.'� r ` -5 L 0`c� <br /> (City,State,Zip Code) <br /> o - 9q3-tv <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> ibis-1ao- 2� f <br /> . — <br /> , <br /> *max *►����. v f <br /> The undarsigned hereby applies for permission to excavate,construct and/or otherwise emoroach on County Highway Right-of-Way on <br /> the—.._tVotzt�, side of Ly°�y ' sst,�s' � _ _—approximately z40 ee mile wac-I <br /> Of C hQ by pelforrling thhe�following work(description of work); <br /> �tiSs��>t,�,-� 1_�l►.'�a"�� S'�+i��1s.`{ ,,��'c��...,t.�e.'��la�h'1 e++..- 17++--�-.5+t��- �t�1 t�'S� <br /> Work wiii commence on or about S-_t,7-o q for appro imateiy _a 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 rulas and regulations of San Joaquin Count+ and subject to inspection and approval. <br /> 'STgnature of Applicant-Title Date <br /> Y�rOAW 4 rEWLATEWCAW.Kro PERW ArPUrAWN.0,,IOW <br />