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09/17/2007 14:44 2094689324 SJCO PERMITS PAGE 02/02 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT. <br /> Date d5p -2 - 0 - - OFFICE USE ONLY <br /> To: San Joaquin county JOB # REF # <br /> Department of Public Works APN CR' # <br /> Tt-�� EXP. DATE /O- /�/c)'7 <br /> �-ttxy-,7t ��,t`1�',(l.ti,-Pc—> VALID /v->3 TO /0--Af DRIVEWAYS: <br /> (Applioant Nene) STREETle4e/ R.4—,_ + <br /> AREA _7rAC!1 QUAD <br /> VAL �M.ij'.ey T k' I.ti`� TYPE <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, zip Code) <br /> `t� le, 2-3ac: <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on ,t� 'e2r 4 sides of <br /> lLr+t�japproximately feet/mile <br /> of by 'performing the <br /> following work (description of work) : <br /> i DC7y �M1.t+ frs�1 `Ji�rvS 2 <br /> Work will commence on or about �r),-( � -T_?-A 2'1 for approximately <br /> `2i 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 /> accords ce with the rules, regulations of San Joaquin County and subject to <br /> inspect. n a d approval. <br /> igna r aApplicant - Title Date <br /> MAFTP.R Df\FRE L Wf)0) <br />