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l~.,, <br />I <br />" <br />/ <br />PlEASE PRINT; <br />APPUCA~ONfOR~NCROACH~ENTPERMrr <br />Dale OFFICE USE ONLY <br />To:San Joaquin COunty <br />-Department of Public Works <br />fG/1S &t 3lt,q04tO <br />(Applica.it IJ\!ame) <br />tf IJ~O LAJ e.tt L..t.fle ' <br />(Mailing Address) <br />~-tt c.k:,:t;o",<!i\q5"~Ol/(citY.State,Zip Code) <br />bacU323 -1l.f32 r>d2eP1e,~M <br />(Area Code -Telephone 1\l1Ji11i1\!r) <br />SI<elch(Detailed plans may be submitted) <br />JOB#73«6,).-1..,,REF # <br />'APN ----~r-CR#EXP.DATE Ie 12 .t <br />VAUD 8122/",~lr tic11 <br />STREET 'AREA Q~D_N_f _ <br />TYPE <br />FORMS <br />NOTES <br />'. <br />DRIVEWAYS:• <br />• <br />• <br />~e:e--5ke-+dA <br />C f'elV -to Cl{1/.>"SCtJ [20 q )1~.3-7L.j:2/'-is w <br />"72.Hb c.t.r>be&o re-.wor-ok:5-t:it r-f..$.c,r-etO j>fAA./1 /"e.fJ..<.esf' <br />-/:>1 '"P'll'-i(.I'",c.\eo-.r-CtIi\C-e It .;-bt-a-VUi-work ~N~4.'HfAfe.-t' <br />1M.-b '1;;kJ.AJ 0 V"e..V\I\.bB-t"\""'Moe M ~."eA • <br />,The undersigned hereby applies for permissIon to excavate,construe!and/or otherwise encroach on County Highwa Right-of-Way on <br />the AI side of FE fe I=t £'e,l',-"ed,'approximately tJ ee mile vJ <br />of %:~I?tl .f1~""~O .by performing'the following work escriptionofwork):____~'J>e-;;e.clohdeJ ,-.L1le !'i 6.1'L E'P-el-t.,'er • <br />Work will commence on or about ~-,;l.~-16 for approximately :2 days. <br />~ND /2':"~3-t6 .I,the undersigned,certify that I am the owner of the respective property,or am qualified to represenl the owner and agree to do the, <br />work described above in accordance with the rules and regulations of san Joaquin,County and subjee!to inspection and approval. <br />~D~•Signature of Applicant -TItle <br />-~o16 <br />Date <br />,