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.. fire ; , • � � � i <br /> APPLICATION FOR ENCROAICHMENT PERMIT <br /> Date 19, <br /> To the San Joaquin County <br /> Iy <br /> Highway Department <br /> Gentlemen: <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway right of way by performing the following work: <br /> (.Applicant will describe here fully what he wishes to do a"sing reverse side if necessary) <br /> +: stkll �i :4r �nitrr ;�, � well nest fel assess tie extort a{ <br /> Stibsorf4re- nvdreco- 1, CA P14bVif. C7t'1tie, pro1 , r5irz, Toe <br /> Vitt( tlest ecg51'sr, C' ftrea k4ler1sitWitit;r! It, y ' x y ' ari.4 . <br /> SctirIV <br /> f.i � t'e�� u +� , ,-s l v d�r rl,s r 1r 5. 6 C1 a n �� � S — Fe r r <br /> Space for sketch f Submit detailed plans if available. <br /> 65ee eoclused Pi4tls) <br /> 3 � <br /> 3 <br /> On County Highway VY cl lr c +vi f o Ay e q Li f ; q p r r c h I M f., �1 C o - f-e e <br /> TeRcgc) in rfrsrf art' yt1( ��st'd <br /> (.Applicant will state here accurately the location of the work he desires to do) 1 <br /> and agrees to do the work in accordance with your cul and regulations and subject to your inspection <br /> and approval. I� <br /> ll0 ' <br /> • Sign Cure of.AppIichnt v <br /> Phone Number <br /> 6 rc4knclty; ter e Clinch f y Jme , <br /> UL, oU Ptke tole. ; 5141 re D <br /> Loci rCed. rl" 54- 5zr, _ <br /> Post Office Address <br /> Permit issued: <br /> (D PW-24 {9/84) <br />