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FROM :CALIFORNIA DATER SERVICEE FAX NO. :2094640195 Jul. 06 2006 10:06AM P 2 <br /> "PL16ATION FOR ENCROA,CMEM PERMIT <br /> Daae 7• O y8SCN USE ONLY <br /> To. San z1oaquin County JOB REF # <br /> Department of Public Works APN # --- <br /> E". DATE <br /> CA�1 R�11R �{ A C S vALm. rGL 1'O r-is_o� DRXVMAYS; <br /> (applicant Name) STREET * <br /> ASSO ( .7 �MVAT 9 'k\M TS . QUAD <br /> (xafling Addraea) FORMS _�� 'Zg r <br /> •S�C�C .0�\ C'� 6 ao s NOTE <br /> (city, state, .Zip code) _.... . <br /> aQl t - IAVw-1,311 <br /> (Area Code " Telephone NU bei), <br /> Sketch (Detailed plans may be submitted) <br /> . SEE AW ArNCHEO <br /> M <br /> n <br /> —+ z <br /> q c o <br /> r �> <br /> CYN C7 i <br /> The undersigned hereby,applies for permission to.excavate, construct and/o,�5 <br /> otherwise-encroach on CowaCy-Highway. Right-of-Way••on•the sif„of . <br /> _17. approximately <br /> /mile <br /> of �tlnS�r—�a� , by performing the <br /> following work (description of work) : ” <br /> r04 A <br /> G <br /> S7T' S.' au4s Ate,, '763000 <br /> Work will commence on or'about 7.3ra4 ___ for approximately <br /> 70 days.- <br /> 1, <br /> ays.I, the undersigned certify that x 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 J'oaqu�n County and subject to <br /> inspection and approval. <br /> 41"'44 _ C-1 - -- '7- 6.06 <br /> Signaturo o ApplicaAt " Title Date <br /> ►aarsn.oslrassao� SS/oo1 � <br />