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" <br />APPUCATION FOR ENCROACHMENT PERMIT <br />,, <br />, <br />I <br />OFFICE USE ONLY <br />JOBt!iloO(l5 REF# <br />APN •CRt! <br />EXP.DATE 5&1-/6VALID6'!fdC TO Jj,t-16 DRIVEWAYS: <br />STREET nnJO IF • <br />AREA 1l11OJ'cet1 QUAD 56 • <br />tyPE lIktv*~z • <br />FORMS <br />NOTES <br />.. <br />PLEASE PRINT:. <br />Date _LV ",;;1(p,It) <br />To:SanJoaquin County <br />Oepartmentof Publlo Works <br />\~egeUA 1ndttm'les 1:-11(,(APPlicant Name)I.. <br />I ~155'[.Stvu -hh 1iIvd-- <br />(Mailing Address)- <br />baJi /-'.A q ~(P3;;t.(City,Stale,Zip Code) <br />;MJfi -<638,/135(Area Code.Telephone Number) <br />Sketch (Oetalled plans may be submitted) <br />'( <br />.oJ <br />,[(Z''--__------.---1-~_.\:J.._~..--':?c~-..'''--'--_..-~_..-.. <br />........_..~::'"".':-;:-_.'-_._~~-;~~..~-'_:.•~:-::-~-'''';,;Dl--t..I)01<-a81(et <br />The undersigned hemby applies for permlssIOn?excavate,conslruct and/or olhelVllse encroach on County Highway Rlght-of.Way on <br />the al e ~0/),,Ill-approximately ;a feellmlle ----of •,,by erformlng the following work (description of work): <br />••f \'\ <br />Work will commence on or about l/-'l.a -"').f2/5 for approximately J days. <br />I,the undersIgned,certify that I am tlle ovmer of tlle respecllve property,or em qusllfled to represent lite ovmer and agree to do \heworkdescrlbedaboveIneccordancewllhtherulssandregulaUonsofSanJoaquInCountyandsubjecttoInspectionandapproval. <br />/(I-::U-/tDale