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;::.~~::.;.~."[.-.r.:~ <br />APPLICATION FOR ENCROACHMENT PERMiTs I,,;j ,,,\':"j/,.c),'n y <br />PLEASE PRINT: <br />Date .:::J'OJ)~cJ 8 J 6 ](0V') <br />To:San Joaquin County <br />Department of PublicWorks <br />CALI [:.Or<tuJ A WATER,2)[tflLJIQ.,E <br />,(Applicant Name) <br />I!.nOd,E .1--AFA\j E1TE ST' <br />(Mailing A~dress) <br />-<:'.-C.-'TbN /11\qS~5~T()lL ~..., <br />(City,State,Zip Code) <br />'dDg\4LoLJ-'2J31I .~:J(Area Code.Telephone N-u-m~be-r)--- <br />JOB#7~0027'REF# <br />APN CR# <br />EXP.DATE ---6~-~i--1~6'- <br />.VALID "L-?!-1L .TO 6-1-[6 <br />STREET we.bel-All . <br />AREA 2/:Qd'fan QUAD ~(~C__ <br />TYPE BeII/QQle <br />FORMS H \~(W(D..q <br />NOTES <br />DRIVEWAYS:• <br />* <br />Sketch (Detailed plans may be submitted) <br />. <br />days. <br />71rrl 0 aD <br />Won(will commence on or about for approximately <br />Lf I~It.oI,the undersigned,certify that!am the owner of the respective prop ny,r am lifted to representthe owner and agree to dothe. <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />~,\i all2f\-0p;s c.Q R AlL-.Signature of Applicant.Tille <br />The undersigned hereby applies for perni~iSSiOto excavate,construct and/or otherwise encroach.on County Highway Right-of-Wayon <br />the 5Mb side of ---Su.~approximately'feetfmile_'__ <br />of &DL mOl\W-i Mn;,D :£.,by performing the following work (description of worl(): <br />~R~)l!::J,1:7C:r .~::J11f~,~~6:;::@I <br />M:\CENTIlALSERVlCESlCI...€RICAl\PUli-SV.WK\lMST1:R.PSlENCRDACHMENT PERMIT N>Pl.JCAllON.IlOC to~!l3J