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JP:.. ... .. V <br />APPLiCATOON FOR ENCROACHMENT PERW <br />PLEASE PRINT: <br />Date f D -e2 g - I S OFFICE USE ONLY <br />To: San Joaquin County JOB# d Q S REF# <br />Department of Public Works APN CR# <br />EXP.DATED <br />r G 1P 1 3,1 6 3 2 7 7 VALID . r Z--rs TO -/- DRIVEWAYS: <br />Applicant lame) STREET Li /a,- -r <br />AREA AD <br />1.19 ah TYPE <br />Mailing Address) FORMS <br />NOTES <br />City,State,Zip Coate) <br />a 3 2 - Mumber)reaCode-Telephon <br />Sket De!a dmalans be submi ePY <br />The undersigned hereby applies forpermission to excavate,construct and/or otherwise encroach on County High wa Right-of-Way onthe1i,J side of L i l GLS St approximately Z 5 ee ile Avo <br />of G,.re t lana e.+ Woad ifi tt Eby performing the following work(Uascription of work): <br />es, S-E C 2 s hn 1P H <br />Work will commence on orabout 2- S for approximately t 3o days. <br />I,the undersigned,certify that I am the owner of the respective property,oram 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 />Signature of Applicant-Title Date <br />LLICENMLSERNCESCLERICALIPU&SV.WKLVASiER.PSIENCROACtU!DiTPERNR'APPLICATIONAOC(UJ73)