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APPLfCATiON FOR"ENCROACHfu1ENT PERM!Tt,,'i;jii~',;'':S!j'il~\\;.iiiT.~ <br />2016jUN \0 PM \:l\4 <br />~',IV' <br />PLEASE PRINT: <br />c/g/'6 -.....-y\Cd Ie Wur<~Date OFPI8~0St:"tJN(Y, <br />To:San Joaquin County JOB#lIocJO£REF#Department of PubITcWorks APN GR# <br />---l Hl e;~Xde-(9Jvv\EXP.DATE ~I'i-fe;.VALID 7jZ.-C TO 2-/5-(6 DRIVEWAYS:~.(Applicant Name)STREET LI~~~elt~1(e • <br />4!)..Or/).'Corovtodo AREA *Av.e.TYPE iW:/~~•(Mailfng Address)FORMS5IvJdo",.J cPr ,9 5d-Ot.f.NOTES <br />(Ciiy,.State,Zip Code) <br />'-fog 6 ')H)IO\~+~. <br />.(Area Code.el phon Number) <br />Sketch (Detailed plans may be submiited) <br />~ctiW-cl1:e,d p-ta,t16 <br />The undersigned hereby applies for permission to excllvate,construct and/or otherwise encroach Mun(y Highway Right-of.Way on <br />the 'F-aA-t side of ~.Yzs A-tJg.U'1l2:>AVA-approximately.'~mile _ <br />of .',by perfonning the following work (desciiption ofworl():. <br />Vl .'<l>6 •nJM.J.~~. <br />f:.o ./r' <br />Wod(will commence on or about for approximately days. <br />I,the undersigned,certify that!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 />.6/2t6IDiift <br />tA:l~SERlJ)CESICI.ERlCAUF1JS-SV.WKII.lAS1ER.PS1El>'CROACHM8lT PEJiMfTAPPUCAT10N.ODC ((I~j3)