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�, L� LVVJ',WLUf IJ JJ V. UUC/UUJ <br /> t <br /> ,APPLICATION FOR ENCROACMMNT PERMIT <br /> PLEASE PRINT: <br /> �� <br /> Date - 1 �.. oFFzca USE ONLY <br /> To: 'San Joaquin County JOB REF # <br /> Department of..Publi.c Warks APN R' If <br /> _ EXP. BAMS <br /> VALID So o TO — DRIVEWAYS: <br /> (,Applicant Name) STREET . <br /> C AR= QUAD _.AIAJ _ <br /> TYPE rlgg aF a #icke-c CE P;r <br /> (mailing Address) FORMS A OF <br /> � <br /> , <br /> NOTE C.l� �1 sti 1 � <br /> (City. State. zip Code)_ <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) &'TcT ,`�C A "' (?C•� <br /> S�'w R:T�.ck'tw4 <br /> The undersigned hereby applies for permission to excavate j, construct"and/or <br /> otherwise encroach-on County--1lighway--Right-of-way on the - l'bM . side -of <br /> L1kC_. _ approximately S r feet/ E 4 S_r <br /> oL (t,, 1a+.1,«-'r . -- - _4.+30M�b�. by performing the <br /> following work (description of work) . _�tp.�1y� c 'ijk. <br /> t%ct_o- ,n'.7E % s '('b &C,# r,. &,V %it St�..cr�. ¢�,wc,i4F tc.l. b+,6-0 <br /> 16 cc,TJ <br /> Work will commence on or about l 3a aE for approximately <br /> L4 days. <br /> I, the undersi. rned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance wit - rules, regulations of San %'oaquin County and subject to <br /> inspection a oval. <br /> L L� <br /> Sicgnature of Applicant - Title Data <br /> KA--r=.P8%rMW0am (6/00) <br />