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.. <br />.'..'.:'(')'~v <br />••~.'•••I • <br />:,\~~-..~..,- <br />I '.•••f•.••••'-'.,••••,I <br />APPLICATION FOR IENCROACHMENT PERMIT _. <br />.~.'I~"~".'.:C~\:~S <br />PLEASE PRINT: <br />OFFICE USE ONLY <br />JOB #75005"2-REF# <br />APN CR# <br />EXP.DATE 6-(-1 & <br />VALID.1-2/-16 TO G-(-/6 DRIVEWAYS: <br />STREET row t •••••R.r1 • <br />AREA r.""/"rltal!!QUAD NW • <br />TYPE -fflZ~• <br />FORMS R:LCf <br />NOTES <br />It-/7 -2,0 [~,.------- <br />San Joaquin County <br />.Department 01 Public Works <br />fb~~f."1.3.1/72180 <br />(Applicant Name) <br />Date <br />To: <br />t.(tP 1..((p IAJ $'+l.'l,'\e. <br />(Mailing Address) <br />Gt~~+6A C~qS~D~ <br />(City,St{;te,Zip Code) <br />{zpq)37~-'1 '152.r-ui::z £~e,ee>~(Area Code -Telephone NllIlIber) <br />Sket Detailed plans may be submi e <br />.The undersigned hereby applies for permission to ex\\avale,construct and/or othelWise encroach on County Highwa Right-ai-Wayan <br />the W side 01 IP t{)er /(0'approximately 0 ee i1e_£~_ <br />of :n~("r"to"iff .7hornt"..,.by performing the lollowing work (escriptionolwork):, <br />Replace fe,Ie <br />Work will commence on or about .1,2 -1 '{-2.a I C for approximately days. <br />I,the undersigned,certify that I am the owner 01the 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 01San Joaquin County and subject to inspection and approval. <br />.&.kut IDa....-,.Signature of Applicant,Title <br />_jl-J7-~C>/~ <br />Date