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APPLICATIGN FOR ENCRCLACHMNT PERMIT <br /> Date October 13 DO OFFICE USE ONLY <br /> JOS to OS- REV <br /> To. san JoagUXU Caunty # � # <br /> I Department of Public Works APN_ CMV <br /> =. DiATB !� �/- D/ <br /> Advanced GeoEnvironmental. Iris. VALID 149"4-IW TO 1- D!—D/ DRIVEWAYS x <br /> (Appl=ant NamC) STREET * - <br /> ARS <br /> 4005 N. Wilsou Wa Tyvz TIFF C N ee <br /> (Kailsng AddreMBI PDRMS - �v w <br /> INO=Stecktoa, CA 95205 <br /> {City, State, Z;.p Code} <br /> r209 467-1006 <br /> (Area Code - Teaephaae Number) <br /> plans ma <br /> Sketch {Detailed Y be submitted) <br /> i <br /> lie <br /> I <br /> The undersigned hereby applies for permie4ion to excavate, construct and/or Thornton <br /> Highway Right-of-Way on, the �.e azide of <br /> .otherwise encroach on County feetf <br /> and Capitol Avenue approximately 423 by performing the <br /> of ' nchin and borin tvRut in a 2" PVC <br /> following work {deacriptiop of works <br /> gjXp.jtne for diacharge. <br /> Work will aouunence on OV about October 25 2000for approximtely <br /> 10 days. <br /> I, the undersigned <br /> aeXtify that I am the owner of the respective property, or am <br /> quel.ifieNd to represent the owner and agree to do the waric described above is <br /> accordance with the rules, regulations of San Joaquin City a¢d subject to <br /> ins'peCtios4 approval. <br /> S tore <br /> to <br /> of Appli <br /> I <br />' w�sseR.Pe�rdts�a (6l�aloo? <br />