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■ E 0El 01/15/2006 11: 53 2094669324 SJCO PERMITS PAGE 01/02 <br /> ■■■■■ ` <br /> ■O APPLICATION FOR, ENCROACHMENT .PERMTT <br /> PST.FAs�QR�N',I`: .• ' <br /> Date Z '/7- 06 OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF ## <br /> Department of Public Works APN CR #) <br /> EXP DATE <br /> S N11n1 lJ�n.,Sr�..J L D..� y✓�iG P✓ LD. VA11 <br /> L ).. <br /> Y,� DRZVRWAYS: <br /> (Applicant Name) STREET ON L!W /& <br /> AREA :27:eK-y QUAD .5W <br /> S 00 At✓e cam/(/,'Ily 12V TYPE ) <br /> (Mailing Addreee) FORMS. Ss &W� _ <br /> 'NOTE <br /> GI'yw�o�a,^ <br /> (City, State, .Zip code) <br /> 92 S`- uroe�- e,, y 3 c r r �1 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed platin may be submitted) <br /> S tc ' A Ott yrW <br /> s pe��a C0YVA i4o�s - e adfar- ►eel-4 <br /> The undersigned hereby, applies for permission t:o ,axbavate, construct and/or <br /> otherwiea•encroach on .Coui:ty•Highway Right-of-Wa:y-on-the .Ser17►'� amide:,of. •• <br /> VOA/So Sfs Rd e� G.e��r Xyc I&/ approximately <br /> of ,MDu.��.(.✓ ifeus� , a�Cw1/ :eet le <br /> -pex <br /> forming the <br /> following work (description o�) ; �Jr_C�.r�s, ar i�G r% zAlel S/3r <br /> fazQ.'K 4-us M- F 9!00AW_- 3:610 RAI <br /> Work will commence on os 'about gr a r; 2 for approximately <br /> days,.- <br /> 1, <br /> ays.-2, the undersigned certify that I am the owner of. the respecti.ve •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 /> Signature of Applicant T'i tle 'Date. <br /> HA9Trx.P9\F=90ML (r./00) ' <br />