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APPLICATION FOR ENCROACHMENT PERM <br /> EGLiVE0 <br /> SAN JOdoul#� ;'.;c: U'�TY <br /> 2006 MAR 2 <br /> PLEASE PRINT: � , <br /> Y ' <br /> 3 ' - (a IISE ONLY <br /> Date r7 C4 C.�b PUBLIC WORKS <br /> To: San Joaquin County JOB # /3079 .7 REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> A 14 T <br /> VALID TS DRIVEWAYS: <br /> (Applicant Name) STREET D. <br /> //� AREA ,�7P QUAD <br /> .C3op 6. C/&97 �/L o TYPEN_-*"PVU <br /> (Mailing Address) FORMS_ L��KJ, i <br /> NOTE <br /> St'b(1t6Yu 0,4 9 S'�) /o <br /> (City, State, Zip Code) <br /> 22/?(/-zh)3 —_ <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the 1IJES I side of <br /> 1211—ft-THE-1PC 0 approximately JyUO` feet/mi'-e /V,047-1-1 <br /> of DU1St / by erforming the <br /> following work (description of work) : TR�/ICN OC) ; ����� o&, Ab E <br /> 7'&919Ha►7F C,46Lj9. 0640_6 '91"� j06 0 ES Ti4 .S7& Slf/S-. T2E64C-tl,�.1VC- 4 <br /> 411-T 4L8A >=4tk" 993 177 7N8y k D 7b 200 ` IAT/8 <br /> B 9�I3 N?A✓J Th►EY <br /> L Ef}3E lZ&,CFC GnC6 6 L_In i Tn 206 ? <br /> Work will commence on or about /9LAae/L /b Z006 for approximately <br /> .� <br /> -days. <br /> t <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 /> 3/ 7/oG <br /> Signatu Qf pplicant Title Date <br /> MASTER.PS\FEESCEDL (6/00) <br />