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APPLICATION FOR ENCROACHMENT PERMIT PECF I rr} <br /> PLEASE PRINT: <br /> 2006 <br /> RINT: OOE1 APR 10 AM <br /> I nn <br /> Date '/ ' V�7 of ��1`II r iC.WORKS <br /> To: San Joaquin County JOB R REF # <br /> Department of Public Works PpN CR <br /> 'EXP. DAT <br /> VALID .7 TO / DRIVEWAYS <br /> (Applicant Name) STREET <br /> ' / ,�/ / AREA A'i 4AriKla QUAD <br /> /O 9O/ /[, l TYPE <br /> (Mailing Address) FORMS W <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code .- Telephone Number) <br /> r.yo.�.¢s 5A r�rA N�bG.o-• 2-X793 <br /> Sketch (Detailed plans may be submitted) <br /> S� l�?17D Dln1'L-, <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwiseencroach on County Highway Right-of-Way on the side of <br /> UAJ10AJ RD. f AlPf- 27- W1, approximately feet/mile AJOK -4 <br /> of 4_47HIPOP ,D. —1-- , by performing pthe <br /> following work (description of work) : - /U�S <br /> A T U (a�S ,�6AV4A ' I A Ii t T M.Poc I <br /> M�Ir�eR <br /> Work will commence on or about for approximately <br /> WL days: - <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 /> 4-,67 <br /> tT� O: Date� a <br /> r-p Tit_- ■ S7 <br /> Signature � nr �.ycant - _ �RN PERM T <br /> PGM <br /> MASTER.PS\FEESC-ML (6/00) ;SOB aQCwwESSM DES BW I <br /> VML - <br /> 8TOCKMN, CA 9=4 <br /> \ <br />