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APPLICATION .FOR ENCROACMUM PERMIT <br /> pLSASE PRINT: <br /> E C:E 1 d E D. <br /> SAN-10-AQUIN COUNTY <br /> Date 6 l 6 2006 JUL, -60. 8 ONLY <br /> TO: San Joaquin County iMBERT. 0yJ&A5z W O R K SRgF # <br /> Department of Public Works APN CR ` # <br /> EXP. DATE 6 61 <br /> VALID• O DRIVNWAYS: <br /> (Applicant Name) STREET Ta i--lep ST: <br /> AREA GCSE W V'1'S QUAD Ae5 _ <br /> (Nailing Addr:e8s) FORMS. �-Z9. <br /> NOTES <br /> (City, State, Zi3P Code) - <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--oa-the (,, .eS'70 aide-.-bf,` - <br /> Tst i 2a1 gTtlk> approximately L 99 feet/mi-kg TVQ-t .tAri .Stmia.> <br /> of GqftT-rC_;4WtJ L'L " `r.14" sr- byy veYf ormirig the <br /> following work (description of. work) (A V7�1L <br /> v C_W (,-.) <br /> Work will commence on or'albout O for approximately <br /> ?� <br /> 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, reguldtions 'of San Joaquin bounty and subject to <br /> inspection and approval ` <br /> Signature of Applicant - Title � Date <br /> HAGTHR.FS\FBz2=L (6/00) <br /> I <br />