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APPLICATION VOR ENCROACHMENT PERMIT <br /> PLE$,SE PRINK': 09-24-07PO3 : 12 CFMD <br /> Data (,� � rJ 0 7 OFFICE, 17SE ONLY <br /> 'To: San Joaquin County JOB # 111Iw5 REF # <br /> bepartman.t of Public works ABN # <br /> EXP. DATE <br /> L/93 6-°RP0.�4-Pani L4Tr�J.•R/044D VAA1 Ka VALID r'-e7 TO /s-o DRIVEWAYS: <br /> (Applicant Name) STREET �>f illlE-OG'T* <br /> 2970 G4TELlAy &JKf I e, r fvrrrt.' 45-0YPEAv .c4 �rAD <br /> (Mailing Ad,dsess) FORMS _% .4.wl 29 <br /> NOTE <br /> ff Y 33 - <br /> (City, State, Zip Code) <br /> 71- ao © 0 - <br /> (Area Code Telephone number) <br /> Sketch (Detailed plana may be submitted) <br /> cpr &wc-muloe-im qEs�pd6) <br /> The undersigned hereby applies for permission to excavate construct and/or o <br /> otherwise encroach on County Highway Might-of-Way On the J LLZATfrlua_ )ids of <br /> approximately feet/mile <br /> of by ''performing the- _. <br /> following work (description of work) : _ASH Ct4,E I»SC e 1p rf ri <br /> Work will commence on or about �`� ����,�Id ��'��''��� for approximately <br /> days. <br /> r, 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 iz), <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval . <br /> Signature of pplicant - Title Date <br /> Ml�'7TAR,q!:\FF88CfIDL {6�DOI " -- <br /> ���S �L/E`N'T ' U� S. ����/ur�� L�Gts��G S �!�7�,���/� . ���C',_�A, ��,r✓r��N'a�- G, <br /> --------- /3U/'Ld/�G 1�D f�®0�+? �. (�,x��- `fD�, 7� /1�J�r�'l�c�n'►ENT` <br />