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2099527381 8-mileenginerring 03:31:54p.m. 11-06-2007 2l3 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date a� <br /> OFFICE USE ONLY <br /> To: San Joaquin County FAPN <br /> REF # <br /> Department of Public Works CR' # <br /> 2-1. 0', <br /> TO JZI- DRIVEWAYS: <br /> (Applicant Name) ,QUAD :56 <br /> TYPEJGei�iJi <br /> c;y� (Mailing Address) FORMS <br /> >IUCOVI'V 9s2_/a NOTE <br /> (City, State, <br /> /lZip Code) <br /> 5 <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 /> othe ise enc ch on. County Highway Right-of-Way on the <br /> � I a�Hside -of <br /> of ( 7S <br /> following work (description of work by performing the <br /> uQ``� ►, E fS17.v� ScIr3 4T,7 or �� ^- P? 7 F( F <br /> 70 E�b�JNG 7vj «, C� �hd X of fc/,.t/► <br /> Loe�ivro Comdr +mss 75 J�J /t�A'`• <br /> �tcfrrc J� `� Vic`` a ,Zc� 6Y'c� c-T r�iY <br /> Work will commence on or about II <br /> S 'b�S 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 /> accor e with the rules, regulations of San Joaquin. County and subject to <br /> ins ectiZ,, a proval�f <br /> Signature of Applicant - Title <br /> b,4-V';6 44 /'Orf-/ Date <br /> MAS SR.MPIRSOOL (6/00) <br />