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, - , .amu tuV:J 1<.l.c 0074 bO7JL4 <br /> 5vw f"tMMI f 5 <br /> HAUL b2/d2 <br /> APPLICATION FOR ENCROACHIdEw PERMXT <br /> PE,EASL <br /> Date v 3 i� (a(o <br /> FA <br /> FICE USE ONLY <br /> To: San Joaquin County REF #Depa.rtmcnt of k'd)lic WorkerCK #sp(TO DRIt4}aYS t(Appli.cant, Na &) /�. k38v ��&{ �- atie.�t�e Sw��c 2IvQUAD -"'_'.�(Nailing Address) <br /> CA 9S8Z I NOTE <br /> (City, state, Zip code) <br /> (916) 5-7Q <br /> (Area Coda - Telephone Number) <br /> Fibx : (W61 7?9 -V737 <br /> Sketch (Detailed plans may be submitted) <br /> -rod Z <br /> p OM <br /> -n r rn <br /> ro p Ci <br /> c <br /> =r" <br /> co a� <br /> M <br /> ZEE <br /> o � <br /> The undersigned hereby applies for permission to excavate, eonetrr}}ssct and/or to <br /> otherwise encroach on County Highway Right-of-Way on the <br /> W. LIroh 9,&.d side of <br /> approximately 3oa /mile 0ti4prf�. <br /> of V v-• s 'Q✓AT- +'., W.&'err� [,ntW : , by'perforn►irig the <br /> following work (description of work) K5 <br /> -_ fa c�•. roaJ o�w� �rarW�y �.-arw � SEE AT'EAC-F C <br /> Work will commence on or about OS a( 06 for <br /> -7 day$. approximately <br /> 1, 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 end subject to <br /> inspectionrand approval, <br /> signature of Applicant - at:le Date <br /> MR9TItll,P/\R1fx5ClWL uroni <br /> Post-)M Fox Note 7671 1 bA1e as ass► 2 <br /> lb� �,fiSL'.✓,tlS From <br /> • Co.rOept, r CO•yyM� . <br /> Phone Tp7�v ��y' � �?hOn�n <br /> Fax <br /> 7�r ` <br /> i <br /> 1 <br />