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2099527381 8-mileenginerring 09:19:53 a.m. 10-31-2007 2l3 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date l0/3)/07 OFFICE USE ONLY <br /> To: San Joaquin County JOB # �.`'�/ =� REF # <br /> Department of Public Works APS CR # <br /> 7-1, EXP. DATE1Z,11-4'10-7 <br /> 14 VALID Zjy1102 TO DRIVEWAYS: <br /> (Applicant Name) STREET <br /> l_ UAD <br /> C >,2300 /687 TYPE �uNo <br /> e <br /> (Mailing Address) FORMS ;2* LVK� "ems <br /> S/ZL,CTWv C/� /,520 NOTE <br /> (City, State, Zip Code) <br /> ��oq) Z/?q- -//?s-o <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) ea <br /> �.� A-T7Y4C,HC� �2�r/vG <br /> The undersigned hereby applies for permission to excavate, co�truct and/or <br /> - otherwise encroach on County Highway Right-of-Way o the �4��Ita�� side -of <br /> zakiC approximately x`110' .D feet/mile Z <br /> of S Mby performing the <br /> following work (description of work) : 'X4'xy Z_yL 15/T U'M12 s/5 or-- <br /> c c t Gq'AgIx Cl,,Ev T N .5eF /au 15CDi2t G77vn <br /> 2 , <br /> .j2 A31 t AWC, R 6CwDLI/f f:&A FLa— h1o,,"E "064 12 2 2 Ad /721 b Zt%USG <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 rules, regulations of San Joaquin County and subject to <br /> inspec ion and approval. <br /> lam 7 <br /> Signature of A p cant - Title Date <br /> Dieu r _ M. Ko&�4 <br /> MAST6R.PS\Pa85CML WOO <br />