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APPLI:CATION .FOR ENCROACHMENT PERMIT <br /> REGE1VE <br /> o1g_ 9g NT:PRISAN JOAOUIN COUNTY <br /> Date C' n .2006 JUL -.6 oFFIc$ USE <br /> ONLY <br /> To: San Joaquin County <br /> DEPT. OF PUBI CJ s0#��//GLS REF # <br /> Department of Public" works APN P5-220-/6 CR ` # <br /> -� Env DATE <br /> f1 I /DJ e17 VALID O Allyllota DRIVEWAYS: <br /> ,(,itpplicapt Name) STREET . <br /> AREA QUAD <br /> r9om v �u <br /> (Mailing Addreiee). FORMS. <br /> 'NOTE <br /> (City, State, Zip Code) <br /> (Area Code Telephone Number). <br /> Sketch, (Detailed plans may be submitted) ��V.�Nr �-h�, r Ct s_ • 5 &U Ld-f r— (� F <br /> 1 ,J <br /> r); 1!v T rCrVt' C� 1'ol/ V�6``S l <br /> The undersigned hereby appl-ies for permission to .excavate, c¢nstruct and/or <br /> otherwise-encroach-on County Highway Right-of-way-on-the % S gid¢. of; <br /> approximately l �Q feet/mile <br /> of dY1-_ Q- k —��r� by"per€orming the <br /> following work (des ription of:work) ' <br /> r >� �2 Gt ca S <br /> , - e e <br /> Work will commence on or'about for approximately <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; regulations �of.San Joaquin County and subject to <br /> inspection and approval <br /> 2A <br /> Signature of�pp - Title Daae <br /> F➢IBTldl.PS\BfiB®L (6/00) `,-`'\ . <br />