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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date CJ _3)—C,6 OFFICE USE ONLY <br /> To: San Joaquin County JOB # //00 S REF # <br /> Department of Public Works APN CR" # <br /> EXP. DATE 9'-0 7-0 0 <br /> ✓w�..+.�n f (.��, �0��',�1� VALID I/ -O TO 17-01 ' -ac DRIVEWAYS: <br /> (Appl cant Name) STREET SgiW&> TOAp <br /> 7 '- AREA-& {�044.,$Q,QUAD /4/� <br /> 1y37 ✓ems TYPE '('mpc.tk * <br /> /L (Mailing Address) FORMS SS�� R--24 <br /> CA 2 SV Z- NOTE <br /> DC dr <br /> (City, State, Zip Code) <br /> zoy - 131- Osiy <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> a O <br /> �- A <br /> / a .Z <br /> O 2311i L <br /> Drr <br /> The undersigned hereby applies for permission to excavate, construct and/oe <br /> otherwise encroach on County Highway Right-of-Way on the Se v f h side c� C)r"GeV" Pew( approximately .Soo eet/mile �l..l�i�(JC7 <br /> ofL.�.....n,✓s L.l by perforrgng'�he.Z <br /> following work (description of work) : >47a.,k., },,*„�L, Ae /t1e.Ar-; /etre -ew4- <br /> F` �7i t �✓e o� ,, o vry cn. <br /> -V/) /r! f I✓ Soo ' /O+ 6rs� <br /> Work will commence on or about for approximately <br /> 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 /> S,. •,�,f.� 8-31-06 <br /> Sature of Applicant - Title I Date <br /> R.PS\FEESCHDL (6/00) <br />