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07/15/00 THU 15:04 FAX 1 91681 04.90 SECOR-SACRAMENTO <br /> Z002 <br /> Jul 07 00 01: 20p Valued Customer 209 -9234 p. 2 <br /> i <br /> • , I <br /> I <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> CT FA4R PRINT: <br /> Esc <br /> 7- /O,OU OFFICE USE ONLY <br /> Date <br /> JOB #�.._�� REF # <br /> To; San Joaquin County APN �� CRV # <br /> Department Of Public Works FXp DATE <br /> SuoR. Tx�e.vw.k:o�l Y'^c. <br /> VALID TO DRIVEWAYS= <br /> (Applicant Name) STREET <br /> AREA QUAD <br /> � r <br /> TYPE <br /> 3011 Ka LLc Ra So it 100 FORMS <br /> (Mailing Address) ITOTE <br /> Zwn cl.o Co+lova, (/k QS(o70 <br /> (City, State, Zip Code) <br /> (g/e} �6/'D'lv0 exf2z3 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) rxc aski(k4, <br /> S,�c L.0 1,qk7mkP <br /> �L <br /> ,7 3 <br /> P CIL <br /> I � <br /> The undersigned hereby applies tor permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-W- on the 61.`£e Side <br /> Sm �w Ft �o> --- _ approximately <br /> of • C o0 °`w+ o <br /> F Sia 151 s )Zt by performing the <br /> following work (description of work) : h VO A beler✓ rae).t. iv olo4AL , 50T1 Sww,Pler, <br /> a �;amtltr So:\ 5w�P1�hg �ler�. •1 <br /> t ri <br /> 17r Ye 4 2 <br /> Sack V:\\ }l.' lcoY...a .kh wro�� kww YD rcc o�.s��c do nose ✓� <br /> vtme�4. .(wn .low uc� Cevcvvarerfr! h�'a F! ,ll <br /> rk Ilk x,ppp for approximately <br /> Work will commence an or about <br /> l,r �ia7`B'• <br /> I, the undersigned certify that I am the owner of the worresk <br /> descriectivebed <br /> property, n am <br /> subject to <br /> qualified Co represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and <br /> inspection and approval. <br /> o 7••10-00 <br /> � �v/6Le f(pR Pyr-'o" /UAA r Date <br /> lt - Title <br /> Signature of APPl <br />