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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT- <br /> Date �S ! Z- ho— OFFICE USE ONLY <br /> To: San Joaquin County JOB# 73c `j'?� REF# <br /> Department of Public Works APN CR# <br /> RGA C EXP.DATE t /O <br /> VALID a0 'holo DRIVEWAYS: <br /> (Applicant Name) STREET �1 n/E Aye <br /> AREA t�� D <br /> (__t fz r l � C i.�. `a TYPE 2 <br /> (Mailing Address) �m tz FORMS <br /> NOTES <br /> (City, State,Zip Code) <br /> Ll2 <br /> (Area Code-Telephone Number) -- <br /> Sketch (Detailed plans may be submitted) <br /> .�.-��-�,.��c-�� <br /> PM it (a✓ ( 7 Sq <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right-of-Way on <br /> the �x�T-i-4 side of SAL-Pi+.tC A approximately Z fee ile <br /> of +.��s �� by performing the following work descrip <br /> �CSiZ tion of work): <br /> iCG�-i�1(� Ck(S 17l�3C IG4 Ellgl-� PSl'JZ7 <br /> �►C�ti© C tGiS 'V.f 1'T14 PR-C:(�G-��y i 1,f1�t'LC 4'Et�/LC—�1L� Q`� �j.t17� .._1t��1t✓�-�tv <br /> Work will commence on or about.At- U_ tC-Ir=-i Z_,,jo for approximately C days. <br /> I,the undersigned, certify that I am the owner of the respective property, or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> l'0 <br /> Signature of plicant-Title Date <br /> E:IP08-SV.WKWASTERPSIENCROACHMENTPERMITAPPLICATION.DCC (07108) <br />