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~FOL Cof../1 ~.$\*0 i,:t:,'i~,i:i~','b:»',:1 Y <br />APPLICATION FOR ENCROACHMENT PERMIf A,' <br />2Q'10 JUN24 Pi~2:00PLEASEPRINT: <br />OFFICE USE aNI.Y <br />JOB#I/O()O>REF# <br />APN CR# <br />EXP,DATE t-r(-I{VALID fr-2-/TO -2-f~DRIVEWAYS: <br />STREET • <br />AREA (Jvra!fg(6~.TY-'lcy Q .A 5/"<'/ <br />TYPE TcP • <br />FORMS 5')£1/4/ <br />NOTES <br />, <br />Date <br />/ <br />fvlA0\'f:;<.A.e,4 q5337 <br />(City,State,Zip Code) <br />92 S)7't3-t/t7 7 <br />(Area Code -Telephone Number) <br />To:San Joaquin County <br />Department of Public Works <br />S&~~'-Ole N (CIS ]?t;1U-1(r (Applicant Name) <br />5t/</I fli'DLlf:>7/<:.1 A L f?Jd e.K.pi?. <br />(Mailing Address) <br />Sketch (Detailed plans may be submitted) <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County High Right-of-Way on <br />the ~Asr side of c.oUJIt L tJO(..L.Ow.:>jtJ).approximately fee ile NOICn..} <br />of "'PEON 'I n12..,TIAc..(,by performing the following work (escription of work):Tc..1>O}-./SNOI4l.-l)'E:.t ONLV Tl>-pi-AU:N"E-tJ CAB<":~0)../ <br />c-.l9sTlI •..?co';:rOuJT YO LG-S.iCe-on ]>(;-ctJY 1DR TO V;4L 7/LO "R.I:>, <br />Work will commence on or about 7-r~-IG for approximately 1$days, <br />I,the undersigned,certify that I am the owner of the respective property,or am qualiJied 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 />Itn'!GooKDrNflofZ <br />pplicant .Title <br />(-r 22-/0 <br />Date <br />M,\CENTRALSER\I1CES1CLERICAl\PUB.SV,WK1MASTERPS\ENCROACllMENT PERMIT APPLlCA lION DOC (09113)