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" <br />APPLICATION FOR ENCROACHMENT PERMIT 2Di6 JUII14 ,,!~In.5')/"'i.{u.v <br />PLEASE PRINT: <br />Date (,It"/It?;,~. <br />OFFICE USE ONLY <br />.DRIVEWAYS:/I/;I/t-II <br />REF# <br />CR#-----+-r-c- <br />'.uf)Q!;2..(,lf <br />(City,Stale,Zip Code) <br />(Applicant Name) <br />lJC:it UU(Mailing Address) <br />San Joaquin County <br />Department of Public Works <br />To: <br />J'.' <br />,.... <br />401,--JIlp-/7 c".7(Area Code -Telephone.Number) <br />Sketch (Detailed plans may be submitted) <br />Sff f;/lHTlA-t-tf Gf)Sl:~TlJd <br />31 L2-<.~-,\{' <br />The undersigned hereby applies,for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the W.•..Yr-side,of -CUM ">,'approximately'I ZZ .eteBttmile AJ~ <br />of vYU"'-1-/.."TOlk..:IDN ,by performing the following work (description of work): <br />I<J"L IL <br />Work will commence on or about for approximately 110 days. <br />f..,/N//L,. <br />Date <br />I,the undersigned,certify that I am the owner of the respective property,or am quaiified to represent the owner and agree to do the <br />work described abo .accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />E:IPUB-<iV.WKlMASTERPSIENCROAGHMENT PERMlTAPPLICATION,DOG (01JllB)