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r.vr I_rnL-i r_n-.i HUD. 20 20U,' 11: bHf`l F .� <br /> APPLzc xzoN Fad ENCROACM=T PERM:CT <br /> QL,EFASL PR�N'l'� <br /> Date --.U9. 17. 1110.7 <br /> OFFICZ USX OULY <br /> TO: San Joaquin County JIOB REP <br /> Department of public Works ?Ll'9 C� # <br /> C.Pr tFOC��!!f-1' ATTR. \!, VLM 6z=1 <br /> a - -07 „mow <br /> (Applicant Namo) S --��-7 . lays= <br /> Toren <br /> S54 V -7�AO V ST ARS Sfixn/ QUAD <br /> TYPE GLE <br /> (3failing Address) FORMSulw, Z9 <br /> NOTE(City, Stata, .Zip Coda) <br /> (.Asea Code xc+lophone Number) <br /> Sketch (Detailed pilaus may be submitted) <br /> SEE /A AP ATTACHED' <br /> The undersigned hexeby,applies for permission to.excavate, constrUat and/or <br /> Otherwise-encroach.on. countyNigbway Right-of-Wa oa the <br /> of - NOR TiL— aidp-�, <br /> approximately ee /mile S ref <br /> following wont (description of work) : <br /> l + by Perfoxmieg the <br /> MA R E F'A Tkcup' aux 3' 13t1L HULA <br /> work will commence on or,about <br /> 6 0 �� ��,s f(�z appxoximate�.� <br /> Y, the undersigned certify that I am the owner of the reap <br /> qualifiedactive pzopezt��, or am <br /> to repres�t the owner and agree to do the work described above in <br /> accordance with the rules, re-eft latIons,of San Jo <br /> :Laspectian and approvalaqudn county axed subject to <br /> . 1U"j 7 Q7� <br /> Y CL <br /> Sika, a of A��Iiaren,t - Title ~ <br /> Date <br /> 10.tz7ac.vs\BSY=C+i�G (G/001 <br />