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2016 JUN ?n Pr"1 2'I 'j•.~.•..I'?I <br />AIP'I'UiGAlf~iClN r-IClR ENCROACHMENT PIERI\IJIi1';'.c;i "'.",,,,._ <br />I ,juLce t/OHi(S <br />OFFICE USE ONLY <br />JOB #13(){J~3--Co REF# <br />APN CR# <br />EXP.DATE vj#kVALID.~B~;;IOJijtj;k DRiVEWAYS; <br />STREET * <br />AREA kt>d2 .QU::!fN * <br />TYPE ,IJle !{tikuFORMS9"(whYNOTES <br />Date <br />4.OLIo tVes,i;'L""i'1t:, <br />(Maiiii1~l\ilil~e5s) <br />:t;'b (;};::_fcdl ,6ft'qs:-~oif <br />(City,Stale?ZilP'Coile) <br />L:2bq).s7?>-1¥-5 Z(Area Cllde •IfeielP'llorne l\f!ml~er) <br />To:San Joaquin County <br />.Department of Public Works <br />ffri £.Po'"3<J23 1670 <br />lliflfiJlieauit !l~sme) <br />"lEASE 1'R!~lf: <br />&~j 6-.2CP/6 <br />Sketch (Detailed plans may be submilied) <br />., <br />.The undersigned hereby applies for permission.to excavatdfonstruct and/or otherwise encroach o.nCounty Highwjl Right-of-Way on <br />the £.side of IJ J Co -jzta R .approximately '/2.flO ~mile F2 <br />of Guo ifl Rd ,I..-OID:r...,by performing the following work (description of work):, <br />Work will commence on or about 6-Q 7 -2.bt K for approximately 2 days.ErJO 11-1:5-:u>tl <br />I,the undersigned,certiJi;that I am the owner of the 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 of San Joaquin.County and subjectto inspection and approval. <br />6-I If -;;wt /' <br />Dale <br />t,tlcerrnALSEIlViCES\CtEfllCALIPUIl-SV.WKI,\lASTERPOO,CROACKMENT f'ERMrf Af'f'lICAnOIU10G (Q':'fl3)