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ADPLICATHOM FOR ENCROACHMENT PERNPHT <br />PLEASE € RINM <br />[Date I " 0 y ' 3,C) B OFFICE USE ONLY <br />0 <br />10: San Joaquin County <br />Department Of Public Works <br />CgwrnP,A 1nin\ ,q1Lyc-L,ZojQE <br />J08IT,;-� <br />APN <br />EXP. DATE <br />VAUD <br />STREET <br />, i C 1 REFS <br />CR P - <br />T74 -2e- ! �} <br />f -I' _ 'r"u TO DRIVEWAYS: <br />(ApplicantNar�e) <br />1 . G H ill FIT, S <br />AREA <br />TYPE <br />c V\ QUAD _C <br />(a[Ifn�A�drd��j <br />�! Y <br />FORMS <br />NOTES <br />v <br />(Gihj, State, Zip Code) <br />(Area Code- Telephone Number) <br />- <br />Sketch (Detailsd plans may be submitted) <br />Sem *k & <br />The undersigned hereby applies foremiission fo excavate, cansiruct andCor othet7n ise encroach on Gounfy Highway Right-oi Way on <br />thei� sideof uckick approximately; - Sc*fee rife s -r <br />of �� 6y pe fo m7ng the following work (a.esc prion of work); <br />commence on or <br />f°rapproximately <br />I, the undersigned, certify that I ant the owner ofthe respective property, or am qualified to represent the owner and agree to do the - <br />work described above in accordance vvith the rules and regulations of San Joaquin County and subject to inspection and approval. <br />D 4lcs4w®nS �I�c�� <br />�i�ra�tnr��fAP d�anf=TIkE� <br />i]CENIAASEZ,9C'ccSG�RIC4LV'JESUWAIMSIE4PS�LTGR0AC115fRRPERM1IG.4pppCA�0k000 (09113) <br />Qat <br />