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APPLICATION FOR ENCROACHMENT PEMNUT <br /> PLEASE PRINT: <br /> Date 2:-:4 &M� IT-1j JOB # OFFICE US�O N LY -- <br /> APN - - CR.V# <br /> To: San Joaquin County Highway Department. EXP. DATE _ <br /> VALID TO DRIVEWAYS: <br /> ss Q'r � 4-kc,i<-'t-r- 1 c STREET _ <br /> (Applicant Name) AREA QUAD <br /> TYPE_ z <br /> lab ?v-"" .., <br /> C. ^06 FOR>VtS _ <br /> (S fling Address) NOTE <br /> Ura <br /> (City, State Zip Code) I Jill <br /> (-Z6"\ 1�:?:)3^ e--i C!J <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County <br /> Highway Right-of-Way on the L-AesS side ofA��-- .+� '''���. approximately <br /> _ ! 4 feet 10e U�of Arm --p, 1, ,by performing the <br /> following work: (description of work): 3,,,-4cj �P �cv�— —.y/ L\��V i{B e"T '� C.r6SiZ �t bY:titiC-e1P <br /> C <br /> tiLal rr.<A <br /> G2GG 1. r^ vm- ti. 1 \ie,- T -YC t1lI T f <br /> i <br /> Work will commence on or about LvZ�k v .;:� _ .,, for approximately '-7 S. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the owner and <br /> agree to do the work described above in accordance with the rules,regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> �} SIGNATURE OF APPLICANT - TI'TI;E DATE <br /> CS 010803 — <br /> City of Stockton 190855-0006 <br />