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10/25/2007 09:50 2094689324 SJCO PERMITS PAGE 01/01 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE_PR:T <br /> Date AIOVevnber,.�l 977 OFFICE USE ONLY <br /> ,,JJ � <br /> To: San Joaquin county JOB # LL_ J REF # <br /> Department of Public works APN CR' # <br /> 1 (� / /� <br /> EXP. DATE <br /> Stale OT�,�' lhGrn1-a-(t//YG�!'�J VALID 7-t-700-' 'TO DRIVEWAYS.- <br /> s� <br /> (Applicant Game) STREET <br /> AI2 A d-J QUAD <br /> P o D 0(X 048 TYPE D45L)e -x4 iLJ Mr 0(" <br /> (Mailing Address) FORMS �,r <br /> %5601 NOTE <br /> (City, State, Zip Code) <br /> (0�0g) W-702015, <br /> (Area Code - Telephote Number) <br /> Sketch (Detailed plans may be oubmitted) <br /> Post-ir, Pax Note 7671 pato Af -�7 W04 _. <br /> R�A <br /> / G� ✓ From <br /> Co./Dopt. Phone d <br /> FThIX d <br /> ':} <br /> �J <br /> The uxxdersigned .hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-o£-way on, the 5o t side of <br /> Locke_�'d. G�' /Zfe. 88 _ -� approximately set mils <br /> of by 'pe'rforming the <br /> following work (description of work) Saw Coa!&menf aeg4je :6t_a e( <br /> WaU <br /> work will commence on or about Mda � for approximately <br /> _ <br /> /0—ILJaye. <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 /> Signature of Applicant - Title - Dat=e <br /> MIAATFR,P9�FE'StlCHI7L [fi/001 <br />