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08/06/2007 13:44 2094689324 SJCO PERMITS PAGE 02/02 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> J&Lr <br /> Date <br /> 7 OFFICE USE ONLY <br /> Tc: San Joaquin County JOB ft 5��7 REF # <br /> rD1epartmennaAlll <br /> tof Public�}Works APN CR # <br /> L�v /'� U/✓l�J'l�� EXP. DATEId-Ir-07 <br /> �7(w (�� VALID -D TO /6-4�^07 DRIVEWAYS: <br /> (Applicant. Name) STREET A6699AYP. 4w. <br /> AREA-151reek7w O&D 115 <br /> TYPE OYJLG fi��K <br /> (Mailing /Address) FORMS <br /> NOTE - <br /> (City, State, Zip Code) <br /> (Area co7wwk <br /> hone Number) <br /> \Jr <br /> Sketch (Detailed plane may be submitted) <br /> The undersigned hereby applies for permission to excavate, con tr ct, and/or <br /> O e w. a n/�ryo c logoou ty`' Highway Right-of-W the side of <br /> �d�- approximately ee / <br /> ofb pleY•orm'ng the <br /> 4rA <br /> f 1 owing w rk (d sc iF�i n of w r <br /> d <br /> Workfco <br /> 11comMepcs on or about O for approximately <br /> IM days. <br /> 1, the undersigned certify that I 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, regulatj.one of San Joaquin County and subject to <br /> inspe ion d Approval . <br /> Signature of Applicant Title <br /> - Title �//]� Date <br /> M(1?•LRR.Pi�FxtFBCF�L !R/CU1 ///// 2V ` 7 /✓� <br />