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64/24;2307 11: 26 2694689324 SJCD PERMITS PAGE 01/02 <br /> APPLICATION FOR ENCROACHMENT PARMTT <br /> PLVASE PRIN -1 <br /> // L <br /> L7e to Z _ 07 Opprox, USE ONLY <br /> To: San Joaquin County JOB <br /> nepart,mfnxlt of Public works APNEXP. DATES <br /> LC - - 'VALID TO `�-c�'' 17ftTVEWAX3: <br /> (Applicant Name) STREET D. <br /> AREA l�c. D QAn <br /> 2 ICtSS <br /> CO 5cs(`TE; /T TYPE(Mailing Adder as e) - FORMS <br /> , C A r aS3 5 61 <br /> (city, <br /> �`- <br /> (CitY, State, .Zip Cods) -- --- <br /> (Area Coda - Telephone Number) <br /> Sketch (Detailed plans may be oAnlit.ted) <br /> d <br /> E <br /> The undersigned hereby appl.ien fox. permiosion to .excavate, construct and/or <br /> otherwise, en.ct, ar_h on County Highw4,y Right-of-way on-the .(ZaAt*, nide-of <br /> �TTapprox Cmatel y <br /> --S!>-Pz"v`� 940.1� T , by:,peyformirlg the <br /> following work, (description of work) : 3 v,- �l'� ��—.4'U�� �it?,���e� <br /> _LLQ 0.1l1�e Arwc 62 5 ao <br /> Wor% r;wi3 commence on or'about yir for approximately <br /> - - - - -_ days. <br /> 7, tl�e certify that I am the .otemer of, the respective property, or am <br /> q:.l,alifir?d La represezat. the owner and agree to do the work described above in <br /> accordance coi.th the xu.les, reg lations 'of San. J'oaquIn County and subject to <br /> nspection and approval. <br /> - , D- 0 <br /> Pre,' � <br /> Sictnature of Appl nt - Title Date <br />