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' -Nov-08 08 ; 36 AM The Davey Tree Expert Company 9164436200 <br /> 4/,q <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT' <br /> OFFICE USE ONLY <br /> Date '1\ t �1 �1 <br /> JOB# //OdO REF# <br /> To: San Joaquin County APN CR# <br /> Department of Public Works EXP.DATE /s i ii <br /> VALID ii TO DRIVEWAYS; <br /> (Applicant Name) STREETAREA �J•dL'1 QUAD <br /> TYPE <br /> FORMS �✓ <br /> {Mailing Address} NOTES <br /> {(;ity,State�jpuCodd�e)) <br /> (Area Code•Telephone Number} <br /> Sketc�'Deea­lallel(—plans7m�aybe submitted) <br /> 14A — 1617'/X 77 <br /> The undersigned hereby applies for permission to excavate,construct andlor otherwise encroach on County Highway Ril ht-of-Way on <br /> side f S t�:s��`-t W�`1 —approximately �� <br /> fe <br /> the t -)eS ,by performing the followin g work(description of work): <br /> of tit+ <br /> tl e SCS <br /> c <br /> _ days. <br /> Work will commence on or about %aQv �4. for approximately <br /> er and agree to <br /> I,the undersigned,certify that I am the owner of the ules andPective property,ulaiions o Sa�Joaquin qualified <br /> nty and subjectto iinspection and apprdovale <br /> work described above in accordance vtinth the 9 <br /> 1 1 -7 <br /> Signature of Appl' <br /> •Title Date <br /> ETUBtV.W4iW8TMPSENCR0ACW& KTAPPMATICNAOC 101iosl <br />