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" <br />" <br />APPliCATION fOR IENCROACHI\RIENTPERMiT <br />OFFICE USE ONLY <br />JOB#7.3<>oS~-(.,REF# <br />APN CR# <br />EXP.DAlE /f~DRIVEWAYS:VALID.1!fil1t...Ill..•STREET r ~(ld<.. <br />AREA R,fo"QUAD 5€-• <br />TYPE ~r\~• <br />FORMS ~/w!oJ T?-l7tNOTESI <br />.To:San Joaquin County <br />.Departmentof PublicWorks.--fG1JE.fll1 3111617j. <br />(Applicalit !\!arne) <br />4p ~0 LA.!e.f.t:L.c\..l\e <br />(Mailing Address) <br />~-t"C\c.-W ",lj\q£".::2()t.j(cij,Stlte,Zip Code) <br />c?0t1)3'23 -Qif3.?fx<.I:i€.(;1e,cM!1'"(Area Code ..TeleplJone lIfumile <br />Sketch (Detailed plans may be submitted) <br />.The underSignedhereby applies for permissiqn to excavate,co s ct and/or othelWiseencroach on County Highw~Right-{)f-Way on <br />,the IA],side of ~,Fret!ev-,'eJ..-:.approximately 10:$0 ~ile,d ' <br />of,Hu-t'e..!Ii'!I ft?f\,&I ".'/},'t:P'I ,byperformingthefollowingwork(descriptionofwork): <br />::La,<"t:4.U t{1r5eV'l'/~2,"'-.2,0..s,'I=ced",/e-tt ,e..d <br />Work wiJIcommence on or abo 7-22-).;_~_~••.••.days. <br />I~NJ)Ik-.2..(;-[6 .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 subjectto inspection and approval. <br />~C>~,Signature of Applicant ..Title <br />__/_-_'1 -",016 <br />Dale