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08/10/2007 08:55 2094689324 SJCO PERMITS PAGE 02/03 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLLp,SE PR T <br /> Date OFFICE USE ONLY <br /> �( V -3000 <br /> To: San Joaquin County Jon ## <br /> Department of Public works APN CR' # <br /> Q 9XP. DATE <br /> V„ALTA9/B�dI TO DRIVEWAYS <br /> ($pPlicasst AT e) STREET Cie a� 40.w/� Y/,C,s1-TS C cn s'It e, 5 AREA A�a4.yl�0D QUAD dam_ <br /> b Z2 ! c'L.50 L' S - _ TYPE CAGC <br /> q (Mailing Address) T'-)RMS <br /> SA�J 11J C (SC (A t' (c� NATE <br /> P(_city, state, Zip Code) <br /> qo( <br /> (Area Code - Telephone Nunber) <br /> Sketch (Detailed planet may be submitted) <br /> The undersigned hereby applies for permiseic111 to excavate, construct and/or <br /> otherwise encroach on County Highway Right-c2-Way on the c--&T K side of <br /> CLKO-S QkLE Lok-0 approximately oc f�kt/mils E-AS7T <br /> of X0 nJ T iA tit :T0 A.0 by peg:€ormin the <br /> following work (description of work) tIL Ll L-r�p_ r40-•t ,t-VV ,g U ekQ <br /> r <br /> }vien .n-.$. 1^u 64. 4 C osore- _>n... h <br /> e oo v d <br /> rk, will commence on or about f1-7 1 Z�'o for approximately <br /> 1 days . <br /> � . <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 ru7.©s, regulations of san Joaquin County and subject to <br /> inspection and approval . <br /> Signature of Applicant - Title Date <br /> MABT9R,P3\P@B9CFDL (5/00) <br />