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APPLICATION fOR:ENCROACHMENT PERMIT: <br /> PLEASE PRINT, <br /> Date t <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> JOB:# <br /> Depad3We-11bUbS' REFS# <br /> rtment of Public Works <br /> APN CR# <br /> EXP:DATE <br /> VALID <br /> {Applicant Named STREET 1 1 TO 12-1 . 2c I DRIVEWAYS: <br /> 4. Rr4. f 111. 1C n <br /> J�Lon � .,�,�.,, t , AREA L 1 QUAD N W <br /> TYPE dV d A <br /> {Marling Adtlress) FORMS SS W W 2 <br /> LL2 NOTES <br /> (City,Stat ,Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans maybe submitted) <br /> The undersi ned hereby applies for permission t excavate,construct and/or otherwise encroach on> <br /> the k � side of - a, a County Highw Ri ht=of-Wa <br /> of approximately /Ov g y°n <br /> /I? 3 4/v ee ile. ��n <br /> ej aL by performing the following work(description of work <br /> Work will cornmence on or.about '�j <br /> t for approximately <br /> I, he undersigned,certify that I am fhe owner of the respective property,Gram qualified days. <br /> work described above in accordance with the rules and regulations ofi San Joaquin County andrsub subject to inspection <br /> and agree'to do the <br /> and approval. <br /> S g at re of Applicant-Title — ' <br /> - Date <br /> - E:IPUB-SV.WKPIASTERPSIEN(23pACHMENT PEWTAPPl1G1710N.DOC <br />