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Adam Killinger, EIT <br /> Prnje�t Enr;ineer <br /> K4 KLEINFELDER <br /> '82-, East mt-rtle Street <br /> Employee-owned �tU<ktor,CA 15205-a-ea FOR ENCROACHMENT PERMIT <br /> 948-1i 45 <br /> 204,946-of, rar <br /> killin�etc�fdinrelder.crmi <br /> www.kleinfelder.com OFFICE USE ONLY <br /> To: San Joaquin County JOB # ��DD� REF <br /> Departmen of Public Works R' ## <br /> j 1 APN C <br /> � EXP. DATE <br /> -- L VALID TO /moi/S—a7 DRIVEWAYS.. <br /> (Applicant Name) STREET /6d"llyf/LE,�D. <br /> V J� AREA 57aleAlVAI QUAD /! _ <br /> TYPE AtWI <br /> _ J (Mailing ciresa) FORMS <br /> NOTE <br /> {City, State, .zip Code) <br /> (Area Code - Telephone Number) <br /> --------------- <br /> Sketch (Detailed plans may be Submitted) <br /> The undersigned hereby applies for permission to excavate, en r ct nd/or <br /> otherw'se a ch on Couty igY7way Right-�of-Way on the <br /> r ! side.of <br /> O pproximately ._ 1� mile <br /> ,° <br /> fbe'formin.g t e <br /> oilot in work (descriptiU7n of work) IO <br /> fif <br /> 914 <br /> 4P <br /> Work will commence on or about h. <br /> days. for approximately <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 rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signa e of Applicant - rite <br /> o Date <br /> MAST .PS\FHB5CHDL (6/00) <br />