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11/nJItib/ lb:l3 L1174bt!'Lb�`j 5iJ JHUiLIUWUKKS PAGE 01 <br /> A_PPLICATION FOR ENCROACHMENT PE&NUT �rr� <br /> PLEASE PRINT: <br /> 9FF+'ICE USE ONLY : <br /> Date AW0116� 'fi /`�`/7 JOB N I!DOS REFf� <br /> APN - CRV# <br /> To: San Joaquin County Highway Department. ENP.DATE /a_/--9 7 <br /> VALID TO DRIVEWAYS: <br /> CAMP 22n' �/�����- STREET/+ccS-rW Z6AO <br /> ('ipplicant Name) AREA 5-MC4--lVQUAD _ <br /> TYPE 570 1( Bor,rtiGG e . <br /> /4f, �,uA9 ue /r� s0o FORM -- <br /> (1•Iailing Address) NOTE <br /> (City, State Zip Code) <br /> �5ro) 933 - 29 oo <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may I,--submitted) <br /> S'EE ,4rr,*e h�- is1 <br /> The undersigned hereby applies for permission to excavate,construct and l or otherwise encroach on County <br /> Highway_ of-ZWay on the ride of-Ay-$174 eo w►o approximately <br /> 5:3 o feet !mile s' rIN of OA -t6,w by P ®meg the : <br /> following work: (description of ti`•ork): O��u- S'c>r� &,eIN6 dvo L1c�Ec> ��'ePu,vcN' <br /> ��rH,a«� �r�rni' �L.xanaV •�`� oN <br /> 47J4u�O MAd <br /> Work`,,ill couunence on or about 17, 1111Y-7 for appro:flmately E._days. <br /> I the undersigned certify that I am the owner of the respective property,or.m.quahfied to represent the owner and <br /> agree to do the work descnbed above 1n accordaaoe 1Yrth the rules,regulations of S1a Joaquin.County and subject <br /> to inspection and approval. <br /> sicnNATURE OF APPLI kmr- - TITLE �7 DATE <br /> CS 010798 <br /> City of Stockton 190855a% <br />