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".i " <br />PLEASE PRINT: <br />.',L.'i UAPPLICATIONFORENCROACHMENTPERMI!I,,",J C ;,U l'!h:C.JH T Y <br />20i6 JUN 28 PM 4:37 <br />Date /;;-11-/1" <br />To:San Joaquin County <br />Department of Public Works <br />~{)tJNi bAILeV <br />(Applicant Name) <br />Po i?:>O)(1 3 <br />(Mailing Address) <br />r:::w a../\,\1 f\i (~llJ\\\I CA.OJ';~3D <br />(City,State,Zip Code) <br />20Cf.68{o-63Z) <br />(Area Code -Telephone Number) <br />Sketch (Detailed plans may be submitted) <br />Se-v AH AUteU <br />JOB #/I tJaJs" <br />APN <br />EXP.DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />REF# <br />CR# <br />DRIVEWAYS: <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High~Right-of-Way on <br />the Bon-l side of f:scAiIW-6(,'11.(>111\Zd.approximately \000 J.e.e!/lhile _ <br />of ,by performing the following work (description of work):St:1J"AH I'\-Ufc~ <br />Work will commence on or about q-2~;}o14 .-q -1)'-1("for approximately __4 .,..5"VlI'2.S •days. <br />I,the undersigned,certify 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 subject to inspection and approval. <br />,/I )tj <br />Signature of Applica t -Title <br />ttl -,2;1-/~ <br />Date <br />E'IPUIl-SV.WK\Mi\STERPS\ENCROACHMENT PERMITAPPLICATION.DOC (OMl8)