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04/131/2007 FRI 11.32 FA,1 2094682999 SJC KBLIC WORKS 2002/002 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE ..PRINT: <br /> Date ti"�a1'� OFFICE USE ONLY <br /> To: San Joaquin County JOB REF ## <br /> Department of Public works APT7 CR <br /> EXP. DATE 7 <br /> call t-O-VIS 1C VALIA -IS-v TO fib' 1�"j DRIVEWAYS: <br /> (Applicant Name) STRS {Zopzm + <br /> _ t� AREA ►�1AQ_ QV-AD t l W + <br /> �L �'. l Y�C�i �r ��G2 TYPE UV— S)Uti A&E.-�_ <br /> �� <br /> (Mailing Address,) Cir FORMS <br /> `�tc�ktooyj se <br /> ( C-A 5-2—C)FD NOTE <br /> (City, state, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> .�� ed MOP X3, <br /> t RAq 1 WtH i <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-way on the side of <br /> approximately feet/mile <br /> ofby performing the <br /> following work (description of work) : ' <br /> 711 Cln';�Ure CT louTe 12 ov, MGu.( IS; l("A- <br /> ro✓ri abs orm Jo erl:cr-m nez.-osparL4 - <br /> ��ct�v� V1 GC- C►'1 GXIS�"jv� d�S�'-r S` c�vev+'iP� i1vG'�'• LU1 it • 't'' CiV�Yt° <br /> i�oul P.r VY10.+� � y'E�1�t� �its to �cWt r of� tn��J ��i1�e'✓� W�tr 'i vt a� c�� ��c�YtS . <br /> Work will commence on or about � � ; 2for approximately <br /> +>nrrC�e _ clays. ("l AM +o 4 PM DAI i,Y) <br /> I, the undersigned certify that I 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 Joaquin County and subject to <br /> inspection and approval. <br /> A5+ LDS-5f-ic+ <br /> Signature of Applicant - Title ' (�r(�f Date <br /> MA9TER.PS\7888CEDL (6/001 <br />