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12/08/2096 15:33 20946851324 SJCO PERMITS PAGE 01/02 <br /> ■ <br /> ■ <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> BLE E _PRZNT: <br /> bate /Z 0 6 OrFTCE USE ONLY <br /> To: San Soaquin County a0B # :�'3o SZ-Co REF # <br /> Department of Public Works APN <br /> EXP. DATE <br /> VALID'`$ itd..= To � � DRrvEwAYs <br /> (Applicant N=e) STREET �t>NAWOF,6 WASE <br /> AREA 1(il.4A4-f60 QUAD <br /> 7Y�L !!/EST LA/✓_E TYPE ?�e-4-11cHiyG `V <br /> (Mailing Address) FARMS _SSwww <br /> NOTE <br /> (City, state, Z;ip Code) <br /> (.Asea Code - Telephone Number) <br /> DW <br /> Sketch (Detailed plans may be eubmitted) CYN <br /> Sr,E �9Tr✓�c��J v4 w� GS.. .. . ...: <br /> The undersigned, hereby applies for permission to excavate, construct and/or <br /> otherwise anoroaah" on County Highway Right-of-Way on the T aide. of <br /> 5S/-a neft _ approximately -t'O� fee /trrJ4e <br /> of 1740/ / /L! 90, LA y performing the <br /> following work (description of work) : —Ae' 7- +��rr.�'NiIV A A�/ ,EXCIi',V, -7-161 / <br /> work wi11 Commence on or about / for approximately <br /> 2- days, <br /> I, the underoigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work deacr.i.bed above J.n <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approvaa.. <br /> Z - C-,;w. - L�tS 7k 122 o 7-1,v llvoet' <br /> Signature 01 hpplicant - Title Date <br />