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�rFPC-Irl�I :CALIFORNIA MATER SERI!I CE= FAX NO. :22394640195 Hug. 1 u 2UU, 1z. ri r <br /> APPS IdW1ON FOR F$CROAC NT PERMYT <br /> p;•EASS PRINT <br /> Date ( 1 OPP= USE ONLY <br /> To: San Joav ounty J4B # 29072 REF # <br /> Department off Public Works ArW -- ._-- Cqz # <br /> DATE _Z0_-/r-07 <br /> VALID• 9-10-0 TO /S- DRIVE'WXY8 z <br /> (Applicant Name) STREET <br /> TYPE 004U- <br /> (Mailing Address) <br /> G(MailingAddress) FORM <br /> 9Q'1 �S4TE <br /> (City, state, ,Zip Code) _ <br /> �,��t� ���~8311 • <br /> (Asea Code Telephone Ntber), <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission t,o.excavate, construct and./or <br /> otherwise-encroach,on county.Highway &,ight-of-PF �S on the .\�IOC`�.Z`'�4 sidp,.bf . <br /> approximately Q' fa '.u+iie E.Ii4S`T" <br /> of� �r��O , �. by vetformiag thefolloV wing' work (description of work) <br /> L� N'Uw v � vtc� �ylnw <br /> IAM S"�_CVVCM <br /> Work will commence oa ox'about :fox approximately <br /> l04 days. , <br /> 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 r regula:tio s'of San J'oaqus n County and subject to <br /> inspection and approval., t Q -14-0-10 <br /> Siq=ture of Applicant Title Date <br /> wtxrsYt.vsl�ac�mr, f[/ooy , <br />