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hear 18 OS 12: 10P Va'-d customer 263 9-9324 P. 1 <br /> APPLICATION FCR .ENCRCACH14ENT PERMIT <br /> PLEASE PRTNT- <br /> Date —N pFF'ICE' 17sS ONLY -- - <br /> TO; San Joaquin County JOB #^ (IC'55- _ _ REF # <br /> Department of Public Wurkz APN CR #_��"��L� <br /> EXP. DATE i5 a5 <br /> VALID a5 TO Who' �7 os DRIV RIAYS: <br /> (Applicant Name) STREET _tAWy 12 �P-17 <br /> C ARZEAGoi i trl2a/li 1_v'QUAD .______}Lff___- _ <br /> TYPE MeN1T'o IT4"� -We--LL.- <br /> (Mailingr A(d�dra5u) FOPMS 55�UVvV, �- <br /> i?�GS.-F'yU� <br /> NOTE. - <br /> (City, State, Zip Code)uzq 461 -two <br /> i <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted), <br /> i <br /> I <br /> I <br /> The undersigned hereby applies for permisolon to exuuvaLtc, conoti-ucti and/or <br /> otherwise encrolajch- onnl�quntyighway Right-of-Way on the ' side of <br /> M23 4W4 93 COQ Irk K� approximately feE�t mile _`QO2-d1_ <br /> of _ (�lSl t2C yeY' <br /> � £orming the <br /> following work (description of work) , tiMOLni-�-06 ai iyLS�77j�0.L to v1 <br /> Work will commence on or about 'Lfor appro::imately <br /> - days. <br /> I, the undersigned certiry that I am tl= uwuGi of tha r, epecz-i•rc property, a:: 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 &.nd .subject to <br /> inspection and approval. <br /> -t"Z JAAa�& <br /> Signa re of Applicant - Title D to <br /> M.7lS'!'Y It.J'tl\CiStlSCIIOL to/oas - <br /> ]YJ <br /> . Il <br /> F <br />