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APPLICATION FOR ENCROACHMENT PEST <br /> PLEASE PRENT: <br /> OFFICE USE ONLY <br /> Date 3-2-M JOB # 11005 REFH <br /> APlq - - CRV# <br /> To: San Joaquin County Highway Deparbnent. EXP. DATE I.floe- <br /> VALID <br /> m ve- <br /> " VALID 4 otP TO 4h57La(v DRIVEWAYS: <br /> h�o�Eg-co 10.R�6AT lb1J D�S'�2r�T STREET j„LLL Y AGC'. /Ar xy?w ". s <br /> (applicant Name) AREA s QUAD - <br /> TYPE_ �Qftt-Q cur _ { <br /> P.D. eo)c 4o4vz:) FORMS �xc, <br /> (tiLiiling Address) NOTE <br /> MD�E STfl C.� , �S'3 S 2 • <br /> (City, State Zip Code) <br /> �Za91 S2Co- -2425 (occ� �2o�S,-(o52-�.00Z �c.�c, <br /> (Asea Code-TcIephone Numbcr) / <br /> Sketch(Detailed plans may be submitted) <br /> w <br /> 'Q .<�t��Lip PLa•ti..e..� �..e.�a 5�`D.. <br /> c. N <br /> 0aQL �f!QsA J <br /> Zo AWAY F►"�" <br /> `l v d LD <br /> P <br /> CL -v <br /> !� u L tZer Le P..\Le <br /> d <br /> ,�E X�S-r ►-e� Geaup v cT 5'�Sr�M. <br /> K <br /> N <br /> 10 M.�_m, GO6.lFLELT -cb ���5 C►1-t� GOA Du�T <br /> S`GST�M ll-.l FLDAjwA.�{ <br /> The undersigned hereby applies for permission to excavate, construct and 1 or otherwise encroach on County <br /> Hrghw y Right-of-Way on the side of uw--Q-e,< p.je P,-C approximately <br /> feet /mile of , Esc mac.o►t ,by pezformiag the <br /> following-,work: (description of work}: -ruder -,k oP au--;�\ aKt:. ez> 4" sup <br /> PVC Goe-�Aub-Ct -Co Goetut'T Sy'smpmvte , Q'XTENI' "CD uSTo► fL <br /> pe�oP�R-c-4' fiorZ r.l.ew 5�.��L� -ro P���Gv�-vv2�L dau►-n.d� <br /> Work will commencE on or about APR.►L -t Zooms for approximately S days. <br /> I the undersigned certify that I am the owner of the respective property, or am,quaUed to represent the owner and <br /> agree to do the work described above in accotdlnce tivith the rules,regulations of Sao Joaquin County and subject <br /> to inspection and approval. <br /> SIGNA11JRE OF APPTJCAINT - =E DATE <br />