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APPLICATION FOR ENCROACE3C= PERMIT <br /> PLBASE PRINT: <br /> Date 1/25/01 OFFICE USE ONLY <br /> To San Joaquin County JOB # REF # <br /> Department of Public Works APN CR' # <br /> EXP DATE 0!-p/ <br /> Wast'em GaD-B-gmeem VALID Z -9-&7-1 TO -O DRIVEWAYS: <br /> (Applicant Name) STREET Ci�un rr v Cfilh 61- <br /> AREA QUAD C C <br /> 1386 E. Bsaper Street TYPE 8 e <br /> (Hailing Address) FORMS SS W <br /> NOTE <br /> WoodLsnd: CA 95776-fQM3 <br /> (City, state, zip code) <br /> _ (530) %9-5300 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> NXE• T)e an Joagm Canty 1hbAtMNt pertm_t # far the GaoM)be legs <br /> M2) axl mit mautcr well M6 is SFEM4868 <br /> The undersigned hereby applies for permission to-excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Wav on the cnfrh side of <br /> Q=try Q__ub Ml d. approximately 82-/Mfee /mile W,-+. <br /> of by performing the <br /> following work (description of work) Usirg dirnnt p rdi eqnp=-. 0-Mnk Ce w te) adran,e <br /> 13 " dlaneter' test p._.�. -,�.�-.�.,.w <br /> of °stab beguTurg80 <br /> west Of the d,ntAa-_ect with <br /> neat <br /> Work will commence on or about / for approximately <br /> -2 daysof <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval <br /> gnature of p13c t Title Da <br /> KASTU PSWURSC6CL (6/70/00) <br />