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08/10/2007 08: 55 2094689324 SJCO PERMITS PAGE 02/03 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLL&k R=T: <br /> Da / <br /> te !40 OFFICE USE ONLY <br /> Zc+Q-Ll6`�-3os� <br /> To: San Joaquin County 10 <br /> Department of Public worke APN CR' # <br /> I- 1 / /� / EXP. DATE /0-/d 7 <br /> VALID 9—/�f,�-,�poD�/yjTTl o /D- DRIVEWAYS,(Applicant Name) 77 STREET��Lfls/1�lJI� <br /> j� AREA QUAD /W <br /> _ <br /> v Z7 ra TYPE �0441171.elAel I&II'L <br /> (Mailing Addreas) FORMSSs/r --Z77 <br /> NOTE <br /> (city, state, "Zip Code) <br /> (Area Code - Telephone Number) <br /> —SkZ o-tch...._.(L1et.a�.].e.d_.p1.a <br /> i <br /> Z <br /> �e tilne�'`�IL <br /> PJ 0Sa'.(el -I <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on Co rnty Highway Right-cf-way on the _�Vo L side of <br /> F t�UA* u,) d 6 '_A4 approximately feet/ eA s-1- <br /> of <br /> -1of Q 1 n aI ; by pe'r..1ming the <br /> ol.lowing work 1(description of /work) ; i��5 �� iHv�•`�eF.,, w . 'T, b <br /> FvLk to_, Leh Ste,, i'c� CD(c�� ra CUf.A—J' X"'4'J( <br /> C (�^ DM 'r�_ �� ' <br /> (J <br /> p"` e L", �l ,e -f <br /> Work will commence on or about for approximately <br /> days . <br /> I, 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 rulers, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of Applicant - Title Date <br /> MA2TMA.P1\7hceCHDL (5/00J <br />