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Af.ru( :A'1'1Q.N FOR ENCROACHMENT PERNUT <br /> ZLE ASE PRIIN'T: • <br /> O USE ONLY <br /> Date _.3- /7-q7 JOB # `730'7�l- 3 REF4 <br /> IAPN - - CRV9 <br /> To: San Joaquin County Highway Department. EXP. DATE <br /> VALID TO DRIVEWAYS: <br /> STREET <br /> (Applicant Name) AREA S%UGk7rz>r1 QUAD N L <br /> TYPE '772�r1c <br /> 44 cy . Yo�c�Ts �}ci• FORMS .SS w ry ie-c �3 <br /> (Mailin;Address) <br /> NOTE <br /> (City, State Zip Code) <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submit-,.ed) <br /> .E�E'•�'O/.ZT' BOE'- ¢M <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County <br /> FlLway Right-of-Way on theE�side of_ u,EsT GA.y� �2��06� approximately <br /> 2 •oak-/mile of ZAA. S- , ic'. "��t/,by performing the <br /> following work: (description of work): -,,e4�XIC�� -7-10 ' c�-c/ T-�/E Alo.eT;/ �.c10 <br /> 6;4S7 4y.441- <br /> To G eg )7A / /7Z3 <br /> IAI L.O!EE/Co dF /1�� C,7- <br /> Work will commence on erebeet for approximately �-Yo days. <br /> I the und=rsigned 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�Zth the rules, regulations of San Joaquin County and subject <br /> to inspection and approval. <br /> 7- q7 <br /> SIGNATliRE bF APPLICAII r - TITLE DATE <br />