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00/02,''2007 09;44 2094699324 SJCO PERMITS PAGE 01/03 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEA�E_PRT1�'": <br /> Date OFFICE USE ONLY <br /> To: San Joaquin County JOg # <br /> !Department of Public Works ADN CR, <br /> USCrV�V1c,J,j �5� 4f•�►JG7�1 G(.Y-�Li� EXP. DATE <br /> VALID o TO �Ly�/o y bRIVEWAX9: <br /> j (Applicant. Namg)� STREET' '�'" <br /> 7it-1 U K l�-►il U&L PP 1 V E AREA 4?UAU -- <br /> TYPE ovia <br /> (bailing Address) FORMS S.5 Le,W <br /> NOTt <br /> (City, State, zip 'Code) <br /> (Area Code W Telephone Number) <br /> Sketch (Detailed plar_,s may be submitted) <br /> Post-it'Fax Note 7671 <br /> J�,d9NN Oi(r' From - <br /> Co,/bept. Co. <br /> Phone It Phone 4 <br /> Fax 1t Cox it <br /> Tile undersigned hereby applies for ,permission to excavate, construct nd/or <br /> ot)aerWJ8e en.croaah on Counter Highway Right-of-Way on the -f-'14+ -)A-�W�s� aide of <br /> c'-TA ?3 fIZ��'rapproximately feet/mile -��c' St < 1hti� <br /> of by e forming the <br /> following work (degcrilption of work) V 1 S f A S �( CctJfF-At:�D <br /> &(iLt-s A 11U-Ve e- L O(Ar;TI vN S t?I ' S`C - T TR e_ vile_ l-C' yv; L L_ B r: <br /> I S� D - L 2_3 cr vu�>_->-s <br /> Wor)� will commence on or about 2,C7 for approximately <br /> ru days, - <br /> I, the undersigned certify that T am the owner of the respectj,ve 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 app,.ovzl, <br /> atuVe <br /> of Applicant Title Date <br /> MAs7rR,F9\PE2BC0L <br />