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PLEASE PRINT: <br />Date ~2,l(., <br />APPLICATION FOR ENCROACHMENT PERMIT <br />OFFICE USE ONLY <br />To:San Joaquin County <br />Department of Public Works <br />~~\.o.\~C>~s(~LdJ,$~ <br />(Applicant Name) <br />""1t>~f:t.p3 <br />(Mailing Address) <br />c?6 \\A'"CA-qsoc.\o <br />1\(City,State,Zip Code) <br />(d:::f1.,5qq .(0 &."I <br />(Area Code.Telephone Number) <br />JOB #//~~REF # <br />APN ~_CR# <br />EXP.DATE 5"h/tfd <br />VALID 6/7ltb'To W<a DRIVEWAYS- <br />STREET lt4IIus/J..R4.HMl2!dI?6I't!,,(vm <br />AREA Rtlb~'QUAD 17&• <br />TYPE 1!'MA'J#Y'~&.-6''''.e6&Ad".)U4~FORMS ,....------------NOTES <br />Sketch (Detailed plans may be submitted) <br />~~~~ <br />M~~%\:W1\<;'lJ/I-b~<:.-\..J.ft)lDJt <Yfb AJ:::,tlJr,-'Jr~m ln6 <br />eo.~Yo.>t'L)~n ().y~.\:\coe k:~~W~' <br />~c...c...Q 1\.0,(W~S-t~/I(~'ii:.-\-Y-Clar.-,S o:t.,\\(.o~LMO()C.Lt.Xe <br />'~1011'S,A.us.~ <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the side of approximately feetlmile _ <br />of ,,by performing the following work (description of work): <br />Y2.-mo,x03.'n......,(0 PP(l;f'"'\.'1.(»)"'-Lu[\JI\O•••$'SlCljls...'\".I.a 'L!..o~kpn..,D-o b ~lJu. <br />\t>Col'>l,,)~\,JD..3h.••k.."\:nu.-.~hlN\Q ,c<,(.)111 b 00 cNT''''b''1 coOcl\[kbMD/lt;:,k:>\C)1S, <br />On"""?l..•••:io>J;~or 6.\rN.CN ",Sg:\,~c:r-.C:')!,"t....Thac.h.1\ <br />Work will commence on or about Mo.-[1,'.:>:)H"for approximately 3 b.,.•rs ~ <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 />E:lPUB-SV.\'MMASTER.PSlENCROACHMENT PERMIT APPLICATION.DOC (o1/6a)