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06/12/2006 16:22 20949F 4 SJC0 PERMITS PAGE 02/0,19 <br /> APPLICATION POR ENCROACHMENT PERMIT <br /> SAN JOAQUIN COUNTY <br /> PL�li9 PRINT <br /> Date _ O� /.3. � o (D DEPT. OF PUBLIC VjoRKS <br /> To: San, Joaquin County .JOB #. /lO�J 'REF # <br /> Department of Public works APN CR " # <br /> r EAP. DATE B/� <br /> ttQvAI�LSEn £ O �n ,loRMEr1 <br /> 74-VALID To 8OF 0 DRMWAYs: <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> S�7 SHAW .ROAD.. _ TYPE !!?;gpE <br /> .� (mailihq Address) FORMS. Sw11. )a 6:09 <br /> S NOTE <br /> (City, State, .Zip code) <br /> no t� <br /> (Area Code - Telephone Number) <br /> sketch (Detailed plans may be submitted) <br /> sfF_ A►►PA14 <br /> The undersigned hereby applies for permission to ,excavate, construct and/or <br /> otherwise•'encroach <br /> ..oonn.CCounttd -Highway R -of-wayy'on•the '�: side.�o£ - <br /> �.r�.--�� p rarely - (ee�milepng- <br /> of Ty per � h <br /> following work (description of. work +o OtL 1e <br /> PiPTgs C- ZU �$ V-Eelow Syrrar t _grADE . 95 4 er R rMAc#.El <br /> SIT£ qN t wUfK PAW . <br /> Work will commend® on or'about AvUsT of Z06.1t for approximately <br /> 3 days. <br /> 1, the .undersigned certify that 1 am the owner of: the respective property,. or dam <br /> qualified to represent the owner and agree to do .the work described above in <br /> accordance with the rules, regulations of San Joaqu"in County and subject to <br /> inspection and approval. <br /> f/SO)FCT <br /> G. ol9si5 /3. Ob <br /> Slgzxatthra &f Applicant Title rDate <br /> MM1RA'BP.4P\tR�Nc10G f6/00) - ' <br /> .1 <br /> i <br />