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APPLICATION FOR ENCROACHMENT PERMIT <br />2016JUN I 4 All II :15 <br />bate <br />To:San Joaquin County <br />Department of Public Works <br />SGft0co ICd R-Is,]'etZrL r <br />/(Applicant Name) <br />Sf/if /;Jj;::JtlST~/4(.~rAt..t.-biZ. <br />(Mailing Address) <br />1-1II uTf:G,4 I (...,.<1 q5'3.3 7 <br />(City,Slate,Zip Code) <br />if Z5)7~3-1./'(77 <br />(Area Code -Telephone Number) <br />--OFFICE USE ONLY <br />JOB #f!OOf}5 REF# <br />APN CR# <br />EXP.DATE -r;-I <br />DRIVEWAYS:• <br />~'S • <br />• <br />NOTES f2.2 <br />. <br />Sketch (Detailed plans may be submitted) <br />Work will commence on or about --7+--~'~/_-~/~{p~------for approximately 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 />M \CENTRALSERVlCES\CLERlCAL\PUa.SV.WKIMASTER PS\£IJCROACHMENT P£RMIT APPUCATION DOC {0S/131 <br />/0-13-/0, <br />Dale