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Jul 17 00 11 : 05a Va*d Customer 20E68-9234 p. 2 <br /> Jul 07 00 01 : 20p Valued Customer 209 468-9234 p. 2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 7- /0-00 OFFICE USE ONLY <br /> To: San Joaquin County JOB # //Cc REF # <br /> Department of Public Works ABN 2N3- 67r1 - 2 CRV <br /> EXP. DATE 00 <br /> secoR VALID 7h71QV TO S / AT DRIVEWAYS: <br /> (Applicant Name) STREET J;WrA lje f0- t <br /> AREA v`fCAIZ/J QUAD �E <br /> 3011 K;lAorc 17.oai Su;ke k0a TYPE '�/G ,2ae1d1'7 <br /> (Mailing Address) FORMS 6U/&K/ <br /> NOTE C,/,5r-r- .•!o. /v//$2 /N Th'E *NOa^/7' <br /> Zav�r lnu CordUVh, CA Q5670 of d200n W14C 66 rlE1U ,AS A !!en/U <br /> (City, State, Zip Code) f^hrulzE r h'A7 rf/E sofa ,ecfa/G N/iLL <br /> xir 6A'f&x7z"-y 4' P-.e '—Z4 K6 aloil <br /> (9(6) F61'04100 ex4- 223 CM/�GETf� / PxoJ�cr <br /> (Area Code - Telephone Number) <br /> sketch (Detailed plans may be submitted) See u 4u(hJ <br /> S•`ic Lour}�ua MNO <br /> s _ � <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on county Highway Right-of-Way on the W, s} side of <br /> Sa ka Ft Roaa approximately feet/t4*e <br /> of '_.l'� 'Z.oJ `^ Uork� uF 'W'er S{Av:slays {�licr by performing the <br /> following work (description of work) : <br /> Dr've a 2" ak ame�tr So:1 SA� JAl" fLota io NO Sraft fv ob}c•n Sof! sa.7P@J. <br /> 1 C un F. 4 a- ar ,,(o <br /> A }(.1q �� vG }he PaVtmt •(a Jc r Cav ma+4s,1 /:('n/ll tui/( I+t oapi <br /> v;l\"A rK <br /> Work will commence on or about for approximately <br /> 3 IAr s JAY&. <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 /> ?ro cc} /17u"k r 7-/6-00 <br /> ignature of Applicant - Title <br /> Date <br />