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12/18/2006 17:50 2094689324 SJCO PERMITS PAGE 01/02 <br /> APPLICATIoN FOR ENCROACH PERMIT <br /> PL El BEL-M.INT <br /> /�/�/o <br /> Date asrxca USE ONLY <br /> To: san Joaquin County J013 #_ REF # <br /> Department of Public Works APW CR: # <br /> / FAQ. DATE 2— D <br /> !-&-o To - 07 DRzvIVATS <br /> (Applica Name) STREET / l <br /> • 3 s� ���5� ,z � <br /> AREA TYPE: �� s� <br /> --- (Mailino Address)-- FORMS Vabla292 •�� <br /> ►�; c C / ci 53 Co 6 NOTE <br /> (city, State, zip code) -- — <br /> �? (� - 5�9� -d0.:)`/ -- -- <br /> (Area Code - Telephone Member) <br /> :%Vxav .�&"'Y Z-9 740-Sz3 <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, c struct and/or <br /> other ise an ro ore County Highway Right-of-way ore the s3:de o <br /> Flak a.� ✓E alfa ;Pe- <br /> approximately /mil � <br /> _i <br /> of 4'/\ by 'p rformi" t <br /> following ^� <br /> work (description of work) : C9i�Q a)d)(, -d_w nJ'l• <br /> Work will commence on or about for approximately <br /> y days. <br /> Z, the undersigned certify that z am the owner of the respective property, or am <br /> qualified to represent the owner and agzee to do the work described above in <br /> accordance with the rules, regulations of Sate Joaquin County and subject to <br /> inspection and approv <br /> Signatureof" Applicant •• Title Date <br /> hu.5TT1R.p6\F808CHCL (s/ao) <br />