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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Data OFFICE uSE ONLY <br /> To: SaJoacruin County 7T-,3-',n5,2-<'o RE, 4 <br /> Department= of Public works APN CR <br /> ESP. LATE <br /> Pgc/f/C �4S ELECTfL��' �, VALID TO DRIVEWAYS_ <br /> (Applicant Name) STREET Lowf;2Z 54crzuucasro_ <br /> / AREA $TrX.KN_,ToQUA <br /> 4 D <br /> Z t/ <br /> 7D yD GSE S 7` 1 4IIIL TYPE -56P-6 + TR ENci� <br /> (Ida iling Address) FORMS R - Z r SS/tow <br /> NOTE <br /> 4MM72D cl eA 9S�o <br /> (City, State, Zip Code) <br /> (,Asea Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> aSEE ����/� PLl9.cls' SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> Ajo 2 rl-IB OOX 7-tAZ 7- ,' j 35' CALIFORNIA SUPPLEMENT <br /> PIn 3D (0 <br /> The undersigned hereby applies for permission to excavate, construct and <br /> otherwise encroach on County Highway Right-of-way on the EAST side of <br /> L=E& .S/9C-RA1YICh/Tb 2L1 approximately /70 feet/auk= .V027'11 <br /> of /YJ,00I1_7L 17E R 1. .STo�'1(T ! by perfcrming the <br /> following work (description of work) : <br /> I'Af IL T'/E-S AKIL) Z19E2� .rill <br /> Work will commence or_ or about for approximately <br /> c1D 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 /> _y z.°.:c__� ;tl^ Data <br /> OE-at-=s -rp,��`�.`" - `y � RE711RN�P/�E�R�MITS TO: <br /> NSSTER.BS+_reesc-M*. !n/caf �ppp�����/���ccF43M �►y BLD <br /> uyV� rT76R/GMM [*SK—®LD 1 <br /> 4040 Wee <br /> ^^� <br /> ��, 6. A 95204 <br />