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APPLICATION FOR ENCROACHMENT PERMNICEIV ED <br /> PLEASE PRINT: Z006 JUN 27 AM 11109 <br /> Date - �3�DlD UGt'�CVff6i3ji'BiORKS <br /> JOB # 7„�J0 REF '# <br /> To : San Joaquin County ASN CR <br /> Department of Public Works EXP DAT <br /> P/�c��iL ��� �cr2ic f0. VALID /7 TO ��- DRIVEWAYS-. <br /> STREET U ' <br /> (Applicant Name) SS <br /> d AREA S7W QUAD - <br /> YO LID (D95r L/'&' TYPE <br /> u 3�l.0 ccs <br /> (Mailing Address) FORMS <br /> NOTE <br /> S'TbG�TOn! C� 950`� <br /> (City, State, Zip Code) <br /> O'D1) <br /> mea Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> SEE /� 7 4,110 <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> SQU61Y _ side of <br /> otherwise encroach on County Highway Right-of-Way on the L�.7L-�ST <br /> 41"AIADICO pyE approximately 6/Infeet/ <br /> o f l-4 y 99 FiQaNTigl,<< 2D <br /> �JG1�KT�jv by performing the <br /> following work (description of work) : sTeEET <br /> x G4 eJ/-1 i-E �.Iot-� ouc2 4S W,4110 <br /> .nvv <br /> To I,ySTJ�L v 2 ss: 3i 2 0vi,�o v ��E. <br /> SERv�cE t <br /> for approximately <br /> Work will commence on or about <br /> ]- ��_Uro <br /> q0 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 /> � - SR. ��45 ESrmwrotL 16-23 '06 <br /> / ✓ © Date <br /> S- .atnra of Applicant Title <br /> � - <br /> RETURN PERMIT'S TO: <br /> MASTER.PS',.FEESQHJL (6/00) PGM <br /> �B PROMSSM DESK-BLD 1 <br /> 4040 Vftft Lem <br /> STOOKTON, CA 95204 <br />