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APPLICATION FOR ENCROACEMNT PERMIT <br /> 40 <br /> ns J&ft PRIT� <br /> 08'FICB USE ONLY <br /> Date <br /> Jos # I 1 006- PEP #_ <br /> To San Joaquin County CR <br /> #� <br /> XP <br /> Department of Public Works PN <br /> EAPN D <br /> To ems- DRI AYB: <br /> (Applicant Na=G) STREET <br /> AREA Q <br /> TYPL <br /> (Mailing Address) FORMS <br /> TE <br /> (City. State. Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 1477fC " <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the Lt1 eide of <br /> zT� <br /> approximately 7S a ee mile - <br /> _ <br /> by performing the <br /> of <br /> following work (description work) : roe <br /> G✓� �� <br /> for approximately <br /> r 2,� <br /> Work will commence on or about <br /> days- <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent theowner and agree to do thework <br /> described <br /> ed abovejecttin <br /> accordance with the rules, regulations of San Joaquin <br /> County <br /> andinspection and approval. <br /> .10 n0-- <br /> r <br /> f� Date <br /> Sigaat a of Applicant - Title <br /> N"M pg\FMMC0DL (6/30/00) <br />