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• 1 0 , <br /> APPLICATION FOR ENCROACHM5M PERMIT <br /> pr BABE PRINT.: 1 c� <br /> Ante <br /> ('IG C'G� I G � u orricz USE ONLY <br /> To: San Joaquin County .APN # ( (D0 5 RES <br /> APN <br /> n Departm((��ent of Public Works ERB DATF / d <br /> /'TTC A5SOC) vo VALID To ! DRIV'EWAYS: <br /> (Applicant Name) <br /> AREA ad QUAD <br /> PC- o TYPE S t <br /> ) <br /> FORt s < 76U <br /> (Mailing Address) NOTE <br /> V� Ja'5 CA �s�(�- ► <br /> (city, Btate, Zip Code) <br /> (Axaa Code - Telephone Number) <br /> Sketch (Detailed plane may be submitted) '- CCTt <br /> post4r Fax Note 7671 DMO z Pagos► ,2 <br /> From <br /> To J V <br /> Co81PPt C0. <br /> Phone S, <br /> Pnonn» <br /> FAY# ' <br /> Fwt <br /> The undersigned hereby applies fox permission to excavate, conepruct and/ox <br /> OL en.czoach on County Highway Right-of-Way on the <br /> w�7, side of <br /> Nisfi M� Sa approximately u- cu a /mile <br /> a ./ a*. by 'per;orming he <br /> of o o k ' « 2 , b r <br /> fol}}owinLJ w rk (description o woxJc) , v ui rl�+ O,o "e <br /> rh. of .Cr <br /> L&rw <br /> 5h2 �cof '1 <br /> t,, a ° 4- for approximately <br /> Work will commence on or about <br /> `.- 14 days. <br /> I, the undersigned certify that I am the owner of the respective properL•y, 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 /> o � p :Z{ Date <br /> ature of Applicant - Title <br /> MA8Tn4,o:\FR86CtmL (61n01 - ,t,f�t} �r��k{ <br />