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APPLICATION FOR ENCROACEMEN'T PERMIT <br /> P <br /> 3E I�s <br /> Date _ /'ZO ,� OFFICE USE ONLY <br /> To San Joaquin County ,708 #_ /nOS REF #�_^ <br /> Department of Public works APN CR # CIl3 b S2 <br /> EXP DATE Y, iS -o / <br /> VALID y 1-oy Tp s=- DRIVMMys <br /> (Applicant N a) STREET /lriSSrOA/ IkL- + <br /> ABPA &TZr-xrr.✓ gvan cc + <br /> TYPE I3seNi oR1.J6i WEZC; + <br /> (!Sailing Address) FORMS _S-rlw 1.y_ <br /> NOTE <br /> (City, tate, Zip Code) <br /> 1� )-4;G"e-.2.300 <br /> (krea. Coda - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> �-ee /7�`_'Ged/ / <br /> �jp7+C, ,fes .�h ✓�G�r/•7 CO�.r�Jlj ��7Cirro�7r7iFW�-� <br /> The undersigned hereby applies for permission to excavate, const and/or <br /> otherwise encroach on County Highway Right-of-way on the P t cside of <br /> approximat ly fee /mile Q CC yf� <br /> of r r y performing the <br /> Alkfollowing work (description of work) �,• <br /> r i <br /> 743 <br /> 42 tx, '~ 'AAV"7 <br /> &24 geweg <br /> Work will commence on or about for ap roximately <br /> days <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval <br /> Signature of pplic - Titl® <br /> Daea <br /> r'�'S='nl ss\1'111i�� (L/)6lODM <br /> a <br />