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SJCU PERMITS <br /> PAGE 01/82 <br /> APPI,KATION FOR ENCROA,CI3MENT PVP.MIT <br /> PLEA99 PRINT: <br /> Date —B�Zi'l d OFFICE USE ONLY <br /> To: San Joacquin County JOB # REP � <br /> Department of Public works APIST <br /> EXP. DATE lD-I-o'1 <br /> wht3.la�X bCU L gcSSo2/�fFS VALID - 216 TO DRIVEWAYS- <br /> (Applicant <br /> RI EW,AYS-(A.pplicant Name) STREET <br /> 34(d �^- AREA LT- <br /> QUAD � <br /> W. 4-�IArM M G7L� l.�J $t.t 1 i L% [ TYPE <br /> (Failing Add ag) FORMS <br /> ,[ OTE <br /> 151 <br /> (City, atate, .Zip Code) <br /> 209 2-3y 2124-1 <br /> (Area Code - Telephone Number) <br /> Sketch, (Detailed planO may be submitted) <br /> 5 E'er' /Qty-cKEb - <br /> The undersigned hereby appl•iem f:or. pe•rmigsion to oxcavate, construct and/or <br /> otherwiee• encroach On County Highway Right-of-Way-on- e Np(� <br /> Eft 2v 4 M 1R21t7es t gide of <br /> of I giprlwl Q� ��_ approxa mately 2oeo j ee /mile <br /> following work (description of. work) : IV�Ba!-lGq�, SOIL 8d2/Mfg sof rmiait bYPP- ong.5 e <br /> MPL I I V!-s AiJ D f+'R1! Z h�N�'St-L Ea IA.'C 1 O� Ta i1 M tC!y�1 u tvl �tar-f.f bF <br /> 114-^4 E 41jo 177.1. <br /> QVIM <br /> btiMTy �G�+�i1�cM� T�, %3+�cK1�/CL�eb <br /> work will commence on or,about 'SES yZ '2 <br /> days. fox approximately <br /> 1, the Undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent the owner and 49ree to do .the work described above in <br /> accordance with pr rules, regulations off San Joaquin County and aubject to <br /> inspection and approval. <br /> Hlgnatuxe of Applicant Title <br /> Date <br /> MA;TRAA19\"R9CML WOO) - <br />