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PLEASE PRINT: <br />•1-'I" <br />.,t.\::.l,:;',:".,.,..yS',"J",';',,c.-',',,----------APPLlCATfONFORENCROACHMENTPERIWIT --!"-'~'~-:.:.:'-'-------~ <br />~...,'~~:,-_'1 .'<11:"1:){.~l~'rl...-.J ('.,.•L.~_ <br />'Date F-eJ-nu 0.,1«if'3,d..Q//.p <br />To:San Joaquin County <br />Department of PublicWorks <br />CA (I EDf?/01 A vi FlTER..~F.~IlOIQ..,E <br />,(Applicant Name) <br />Il.oo3EkAFAVETI'E ST <br />(Mailing A~dress) <br />-.sTO Q.'t-Ib N l!A qSd-D5 <br />(City,State,Zip Code) <br />'dog~Lf 10 lj -'2;:3 J I <br />~(Area Code.Telephone Number) <br />Sketch (Detailed plans may besubmitted) <br />JOB# <br />APN <br />EXP.DATE <br />VAUD <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />.~i"ii.c;~(~:~.. <br />OFFICE USE ONLY <br />DRIVEWAYS:• <br />The undersigned hereby applies fi r permission.to Ilxcavate construct and/or otherwise encroachon qpun!y HighwayRight-of-Wayon <br />the Noc-f.b sideof'.,f .h approximately 0'?R ~feetlmile ' <br />of '.,by performing the followingwork (desciiptio-nof -w-ork): <br />Work will commence on or about fi7ap~oximatelY days.y 15 I(p <br />I,the undersigned,certify that I am the owner of the respective property,a qu lifted 0 representthe owner and agree to do the. <br />work described above in accordancewith the rulesand regulationsof SanJoaquin County and subject to inspectionand approval. <br />__~1'2 J~jl;_ <br />~e