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APPLICATION FOR-ENCROACHIl,1ENT PERM!T <br />PLEASE PRINT: <br />Date '¥.~/?...-(?l6 <br />To:San Joaquin County <br />Department of Public Works <br />H~/JMld6A/"' <br />(Ah&JTIiz~c#/-4J0/fr-ifJ-~ <br />,(Applicant Name) <br />6~S/iJ?e1 C{J:/;er;WII?56; <br />(Mailing Address) <br />L?t/:0?'.....;C4,9C!S-61l,, <br />(City,.Slala,Zip Code) <br />/i-.?5)5'S1-7S-SS _ <br />-~(Area Code.ialepllone Number)J1ftOlv C/./60 6j--R-i/vZ',COm <br />Sketch (Detailed plans may be submitted)PUIs"~R-6//l/cL-//O!3:0 <br />12-5rG'-GVC17 rcP -.-8:'7tJ /f/7,?'3 -61»;7IJiJI/Q~tJt/,iV/f-?f#,.y'Z....<t5 _.,"",I J <br />OFFICE USE ONLY <br />Wadewill commence on or about /1$l.tf;L/~for approximately I days. <br />I,the undersigned,certify thall am the owner of the respective property,or am qualified to represent theowner 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 />~&-' <br />,_Signature of Applicant.Tiire