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Jul 07 00 01 : 20p Val* Customer 20*8-9234 p. 2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT : <br /> C7 r 1 OI FAPN <br /> FICE USE ONLY <br /> Date <br /> REF # <br /> To: San Joaquin County CRVDepartment of Public WorksTO JDRIVEWAYS:2 �nler�at o,,a� nC <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> TYPE <br /> �o�'� ki 'OJ'2. � S•; ?� }00 FORMS <br /> (Mailing Address) NOTE <br /> {Zarcho Ccs-4cv \ CA Ci s6 70 <br /> (City, State, Zip Code) <br /> X 2 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submi ted , <br /> _ . —PT- C)FC} a ( <br /> �wh r � Vi <br /> �(A �C� slops <br /> of <br /> �— e E 0f ave Ma ni- <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the �Cfefeet/mile <br /> � side of <br /> mately feet/ <br /> aroxi �-- <br /> Sot}h Saw'�a Fe. (Zoa� PP by Performing the <br /> ai 200 YaC s ucr}ho� ih� Shwa - Sard��i n4 -0.14-e_ <br /> Q -2 , C 1'PC-' ,SOt} 11 +Va <br /> following work (description of work) : ��nawG'l-er Sa 'k_ I <br /> S e� �lov✓ ra !0 6ia�� $o - w' I dril <br /> roar fron sae , n + <br /> av21rQ'N*- ed SoA n c a V. Co n E W V 1."C <br /> (gyp } aSi <br /> w• ( � 0�� ,1,e }o o6cerd2 for approximately <br /> Work will commence on or about <br /> J days. <br /> the owner of the respective property, n am <br /> I, the undersigned certify that I am <br /> qualified to represent the owner and agree to do the work des and subject eto <br /> accordance with the rules, regulations of San Joaquin County <br /> inspection and approval. <br /> 3/O(Date <br /> Signature of Applicant - Title <br />