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APPLICATION FOR ENCROACHMENT PERMIT <br />,'_C::i:':cr;S;\I':j :.';\,j .Jlr<:.~~.)HTY <br />* <br />DRIVEWAYS: <br />Is J'".mi~,,6 L:fn <br />~C&'*. <br />.'-.,".....~,..a/:\.OIJ'.-r <br />~:;~j-'1 ~):',t-~~otf-J~UJ1\b;,:} <br />OFFICE USE ONLY <br />JOB# <br />APN <br />EXP.DATE <br />.VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />PLEASE PRINT: <br />Date J--Li~.~)j.o i/o <br />To:San Joaquin County <br />Department of Public Works <br />CA LI FDf2.f()/A WATERc5Iitfl(j I~E <br />.(Applicant Name) <br />liooa,EI--AF-Ej\jETIE ST <br />(Mailing Address) <br />..STOC--lLTON CJ1 9Sc:}o5 <br />(Cily,State,Zip Code)'~0~LJ 10 l/-'2;31 1 .~(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted). <br />The undersigned hereby applies for pertJi~ssion to excavate,construct andior otherwise encro~h.on County Highway Right-ot-Way on <br />the No,+~sideof'IOQ\(),A..approximately ~I feet/mile lu<,o+ <br />of .()Q ,,,,\-'1',10-.(I~•.,.,by performing the following work (description of work): <br />?nO 0 £54,,*£-,~~OJ.A.i ~~P9il\I2)fi3,~~f~'3;-ff'N.J\s;sN'~.VZ1D)0 00 <br />]9Won(will commence on or about foJPproximatelY Ia 0 days.$1C:;1iS> <br />I,the undersigned,certify that I am the owner of the respective pro ertY,ora quali led 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 (0 inspection and approval. <br />, <br />.M:\l:EmRKlBERIlJCEStCI.ERICAl.\PUB-SV.WKllAAsn:R.PS\EN\:ROACHM8lTPERMff APPUCA110N.OOO [~g[13)