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by:UE From:1 1o:1r_'by1+bbc:!'Jyy rage:if,3 <br /> APPLICATION FOR ENCROACHMENT PL%XIT <br /> PLEERINI:. <br /> Date Z J Z1 01 0"ICB uSB ONLY <br /> To_ 5aLn Joaq+ai.n County JOB #k OC J� - REV # <br /> Department of Public Works A.PN <br /> EXP. DIT 0 0 <br /> - VALID � -7 O TO S 4 DRIVEWNYS: <br /> (AppliZt Name) STRZZT <br /> )r AREA 1.55C-q ZOAt OAD .sem•••— « <br /> V1 UC . �i F.^ TYPE •T1C 64 1!, fiIZI**-Z BMJ 2E <br /> ` <br /> (Mailing Addreea) FORMS ✓� <br /> C�' 2S NOTZ <br /> (City, state"Zip Code) <br /> 1110-10 <br /> (.Area Code - Talophone Mmberl . <br /> Sketch (n®tailed plana may be submitted) - <br /> P �4 r7/+W G%b DE 'rO UAL P jA Aj <br /> o .. <br /> cn <br /> CA <br /> The undarmigned hereby applies for permission to.exc&Vftt®, construct and/or <br /> otherwise-encroach on County.. Highway Right-of-Way On-the . F0%A. GI�s�.R�4ida.•o£. <br /> BNSF X11NC., oN A!/ENA RD, Approximately z1 000 fees e <br /> of CA BOLTON RD. by VaTiox•ming Che <br /> Collowing work (a.ascripti.orn of work) : RENEw1rJ Cayiex, 12!zMC:&% XI$7W 6 <br /> ecANlr f �i9 P/N G NEw r1 F S , AN/� RE -pal v/N G _TFLe <AoE&N or+ <br /> AvsNA R,RXfNGATTAf.Ll49 fS A coAN of �H DFrnu7L I�oyTE <br /> work will commence on or about $ = 07 for apprvximateLy <br /> Z daya <br /> I, the undcrsigoned ctxt3ify that i am the owner of the rempoctive property, or am <br /> qualified to repre9ent *6 owner and agxcc to do the work doacriked above 3.n , <br /> accordance with the rules, regulations'of San Joaquin County and subject to <br /> inspection and approval, <br /> / '2- _ Z7-07 <br /> Signa use of Dppli nt - itlo Date <br /> i <br /> I <br />