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SEP-15-2089 12:48 From: To:2094689324 P.2/3 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ZocR OFFICE USE ONLY <br /> To: San Joaquin County J08# REF# <br /> Department of public Works APN _ CR# <br /> AA1 EXP.DATE D•/S• Off} <br /> G RLL E Q fJ L rQ , N(' VAl.fO 4^78• TO /-0 DRIVEWAYS! <br /> DRIVEWAYS! <br /> (Applicant Name) STREET A?t Aff a ,Qy, <br /> � ,8C1�}`�Fr��• AREA L„vxXA QUAD n�E <br /> TYPE <br /> (10I1ieg Address) FORMS <br /> NOTES <br /> (Cigr,State,ZIP Code) <br /> (Area Code•Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> PZAC 9 T91-rPW o NC 4f h ILLS' QIu W i wt 6;e pop <br /> lljEk) Cu.s-rcl m&7z. S c P-u L C - , <br /> SEE .47TAC RE D P R1 NT FQ j� LETR lLS', <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway RIght•of-Way qn� <br /> the��side of k}I M ph�_�^.___approximately I,2_ fee <br /> Of 111�+�JIG SI 7 t'� by performing the following work(description of work); <br /> I gallan ja <br /> 4 <br /> I <br /> Work will commence on or about 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 descrlbed above in accordance with the rules and regulations of San Joaquin County and sub*t to Inspection and approval <br /> Q tai-7 <br /> urs of Appll nt•TitleaEN4 <br /> cwuaavi�wwrcnwu�rcnaexcxrvvWr�ennnioac roue„ <br />