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VD/ IV/ZQVr i0.VV rx�c <br /> lf/J V V L/V V.i <br /> APPUCA TION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 5-30-07 _ Ac_-r. * 7 3o$2- <br /> To: San,Joaquin County-Highway Department OFFICE—USE ONLY <br /> JOB# 30570475 Rl✓F# <br /> PQj&E AFN 227 - 030 - 20 CRV# <br /> (Applicant Name) <br /> EXP.DATA -7- <br /> 15-24-N. <br /> -1.524N. CARPENTER RD. VALID Zao TO e) 7 DRIVEWAYS: <br /> (Mailing Address) STREET <br /> AREA QUAD 5 <br /> MODE <br /> STO_C.A,, 95351 TYPE — �p CORMS Ss 1wJ !C-Z <br /> (City, State,Zip Code) <br /> NOTE geZ4 <br /> 209-576-6603 _ <br /> (Area Code-Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on <br /> County Highway Right-of--Way on the _ _N side of DECK RD. <br /> 855' <br /> approximately feet/mile E _ of ESCALON BELLOTA RD. <br /> by performing the following work: (description of work): <br /> Work will commence on or about 6/20/07 for approximately. 2 days. <br /> I the undersigned certify that I am the owner of the respective property, or am qualified to represent the <br /> owner agree to do the work described above in accordance with the rules, regulations of San Joaquin <br /> County and subject to inspection and approval. ; -y <br /> 'KIGNATURE OF APPLICANT-TITLE DATE <br />