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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date fa Z//6o OFFICE USE ONLY <br /> To: San Joaquin County JOB # �lt�o, REF # <br /> Department of Public Works APN CRV # g-, f-2`/ 7 <br /> /^cc -� �1� EXP. DATE `� <br /> �J� ItLFCO�I l.�LfFORN/A . /NC.. VALID '//'�'/ TO i-/Sol DRIVEWAYS: <br /> (Applicant Name) STREET 14,ya5 G,(u,y f.,ns <br /> nT� <br /> AREA Ai L QUAD ALL <br /> .?30oIOA K D A L i Rc*y S TYPE ju-rm _ Fim m -: - C.-fg.ic <br /> (Mailing Address) FORMS R-Z9 W Exasr(Nca L).Lc_rs <br /> I"I0 D ES ro, C A 9535- NOTE <br /> (City, State, Zip Code) <br /> CPA V,o Fowr_ets <br /> (3032 SSS!-5-000 \PRost C_T J L_2 )_ <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) Scrkr .47TACA" ri fN R&4AI S <br /> A ..3cePr os W*A-04 FUR 1r16,nt. 1�rTil�cwfi�,v <br /> F• Mr►ps/LbCIIT/ONS - MooEs� Ts <br /> t3 . 1N,Su,(iANc� CoRrr>< tawTa 5AC.4L^f-j1rtJ7-0 (X4A'ToA4kv," a0-) <br /> C Cb Py Vic : CEQri F,c-#-TYoF FJeL1 t AS- Sur(_TS - AdoDrsro T• SAGrtAKEN" <br /> CeaA!r/ENra'At" � AI c,J3 / ry CSAN Toastu,wC.Q.) <br /> CAa TR•.NS $Tw .up,a It Ds <br /> 14 . MnPs/t.ec.4T,ov r - TRwcy fib Fivma yr <br /> (SA 1-1 -TOA Lui•v Leo. ) <br /> AC. r-rplc.fl ` HAONoILd/h,APPWVLdr t. A S- 13u r Ll-.F- -rot lacy ro FAirm oNT <br /> D P_ rR t L C SA N 3741 dtu,ru Lse. <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on tfts- .t iTat.4 side of fioAoS <br /> As 4p:Prereo 04 FxHidir approximately ye. 7 fsw4t/miler to7we Movesro To <br /> 69t SAC,eAM PTO LWrff ds 1.7 c's ow TMS Rw�y ro FacM•Nr R•vby performing the <br /> following work (description of work) : 1mswx-r,wc F(acx Orr/e-C_Airui to ve THE cx(sr,wa <br /> i!pUDt3,T R- As fwJSTALstD a%# GST Uflur, 706- 6X1tr#oj& 7Q LOGAroapis am TMir P1 oyclTO <br /> :M 9A'-&�. WAJTo u-rE & iLtimr, THE zrAes7-/,vi6 (00 LbcArtoAJS ioa Ttlr- Trtwcu To <br /> Fs-Ei.An.UIr mo lar it <br /> Work will commence on or about _ 0"yrr'w'rg l /S. 7000 for approximately <br /> /e'4� days. <br /> I, the undersigned 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 with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant - Title Date <br /> XASTLR.PS\FLLSCJDL (6/29/00) <br />