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.' <br />APPLICATION FOR ENCROACHMENT PERMIT <br />To:San Joaquin County <br />Department of Public Works <br />PLEASE PRINT: <br />Date 2-24-1& <br />f'6~E, <br />IIZ'7'1 <br />N:ltTI4/.../e sw/ETI4NSJ:-1 <br />(Applicant Name) <br />1\1/0;v'iita /U)•(lIi1ing Address) <br />OFFICE USE ONLY <br />JOB#7300>?REF# <br />APN CR# <br />EXP.DATE ~~~tbVALID DRIVEWAYS: <br />STREET 4fjrf ;~iJ{S-IJ.• <br />AREA fy-ea:hrq""a QUAD 5£• <br />TYPE i •(Sore <br />FORMS S-StYW'&29' <br />NOTES <br />ell/co.C,</.r5"!Z'6 <br />(City,State,Zip Code) <br />(5?>O)13'1b-4'5'07 <br />(Area Code.Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach~!1 County High Right-of-Way on <br />the .5~{)TfI side of w.MIt7TJ'lew.s f].P.approximately 4JI1jO ~"6 fee i1e li/!&T <br />.of 17£./6ftT -IZ/).,by performing the following work escription of work): <br />Work will commence on or about for approximately days. <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 ruies and regulations of San Joaquin County and subject to inspection and approval. <br />_PESI6/J eJGINfet-CCIVTff/..ItItC:2 <br />Signature of Applicant.Title <br />E.~PU~SV.WK\IMSTER.PS\ENCROACHMENT PERMIT APPLICATION.DOC (01108) <br />'Z-Z?-I(" <br />Date