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"" <br />APPLICATION FOR ENCROACHMENT PERMiT _.i".L.'SId.!j 0 .r-\I.J Ui0;1'-,0,)('1f ' <br />C WOHK <br />P~I3:12it,.. <br />;i .~.}"~I ~OFFICE USE ONLY , <br />JOB#730077 REF # <br />APN CR# <br />EXP,DATE 7 ../(J-{G <br />,VALID '(-L.4 ../G TO 7-10./6 DRIVEWAYS: <br />STREET f}!JJd'hftbt4 A 1/.• <br />AREA *QUAD (C <br />TYPE T•..~.• <br />FORMS if R.2..7'NOTES....,...... <br />PLEASE PRINT: <br />Date JY\our 31 }.;x)IlJ ' <br />To:San Joaquin County <br />Department of Public Works <br />CAlJt:-N2.f0/A viFlT£f?.OE(I,.Jj)~E,(Applicant Name) <br />lloaa,E I--AFAiET[E ST <br />(Mailing ddress) <br />-STa <2-'1...1'0 N 01 qS C)..05 <br />(City,Slate,Zip Code) <br />~g\Lj Lo'-l-~3J 1_.__0"::J(Area Code.Telephone !'lumber) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroachon County Highway Right-of-Way on <br />the sideof ''approximately feetfmile _ <br />of ,,',by performing the following work (description of wor!(): <br />~ht~~~~E?*~K~l;,g~¥i511&g~I)~Ri);Q(J6%~~o <br />c,~l=\-::,')(50'.x 11,J..:<"flu'CLAtl-10<y ,'\@ct ID 3Lf50 ..1.- <br />Wont will commence on or about for JPpro~imatelY days.('q 15 I'\.u ')7-8-1.(; <br />I,the undersigned,certify that I am the owner of the respective property,or am quali led 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 />_--=.513i\1'~. <br />~ <br />M:\CENTFJ\!.SERVICESlCI.ERICAL\PUS-SV.WKIIMSTER.PSIENCROACIlMENT PERMIT JlPPUCAllON.DOC [fl~113J