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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Dale S -?-(Co I!OFFICE USE ONLY <br />To;San Joaquin County JOB#1/000>REF# <br />Department of Public Works AP~J CR11 i <br />----J /'/,./EXP.DATE --=7~-1~$-'-lh ---~I <br />Jr-')"I lC,.1\y-~(..!,c.;n--,VALID b-Z.-!t;TO 7-/>-71,?:_,.ewm&! <br />(Applicant Name)STREET ~-;;~----ce=-~~~--.. <br />I AJYoR~.EEAr.AS ~~•QUAD>-:tff?,jo18 IflCH(~1<\.V1f ~-~--I(DMlilin9Address) <br />..---~:clS--""-(C~te,z;;o~.c!~7~__~_"t:>--_N__O_T_E_S~_~~__~~~~~~__~~~-~~_-~~~~~~-=----11--- <br />C,I ] <br />Sketch (Detailed plans may be submiited) <br />The undersigned.hereby applies for permission to excavate.construct and/or otherwise encroach on County HighirJayRight-of.Way on <br />the 6 ...d of iJ..,l sideof Yl--'",L.approximately_-feetlmile _ <br />of •by performing the following work (description ofwort<):--I-o--I--\"-"-'-L-C-""-'-C=-{--U-c-({-E'-.---~;'-N-,,-"-'k-c:.-<.--,-A-:fj-.<k 1,<f t.--C'l'\..{'5"<v V n:.e. <br />..1i,1..t:'--'5'e--,c<rci3(,t'lll"sLlC•••••• <br />Won<will commence on or about __;:;_-~Ol~Y_.~/_{,.~for approximately t,-ZC/.(lo $<7 days. <br />S'"'-'1-!(;, <br />Date <br />I.the undersigned,certify that I am the owner of the respective property,OT am qualified to represent the owner and agree to do the. <br />work described above in rdance with the rules and regulations of San Joaquin County and subject to inspection and approval.l' <br />(.., <br />-Si nature of Applicant.Title