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12/27/2007 09:58 2094589324 SJCO PERMITS PAGE 01/02 <br /> ■ <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PL ME PRINT: <br /> Date i 2—S — o3 OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Depa:i:tmeng/t)�✓oyf, Public Works APN CR' # <br /> EXp. DATE ���- <br /> rt VALID ! —ek TO /�-t� r)P,1VEWA.Y9: <br /> (Applicant Name) STREET <br /> t AREA v2tLTA QUAD d <br /> �'-7! ) Wi �'p1 2S� TYPEGL �= <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, zip 'Code) <br /> '2,5 - 97y ., Li330 <br /> (Area Cade - Telephone Number) <br /> Skotch (retailed 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 the Aide of <br /> (m.,_ approximately feet/mile <br /> of :6rrar 3� by 'per <br /> forming the <br /> a / r � <br /> fo <br /> )rlown wo,r]t. (descri tion of work) : %�" c;� ' ` <br /> P 1341 t i r� <br /> ijLi <br /> +_I �c•N��M ti);, /' 1G,1✓1 'fSj" COY✓?f U/� r 3 ' G a y' 7S <br /> a►ld- Db. <br /> T ' <br /> Work will commence on or about G,C,/, � 'f 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 owm.er 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 /> Signature of Applicant - Title Date <br /> MASTER.ea\FEEBCRDL f5/001 <br />