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209 9527381 8-mile enginerring 10:32:40 a.m, 03-21-2008 2/3 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 3 log OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN CR' # <br /> Q <br /> EXP. DATE /-Cha <br /> / TAT VALID ' TO DRIVEWAYS: <br /> (Applicant Name) STREET MWIO 2.RY CD. * <br /> AREA QUAD <br /> &X&hE A"A?n TYPE <br /> (Mailing Address) FORMS <br /> Q NOTE <br /> (City, State„ Zip Code) <br /> X09 -�17q_ 1106/ r <br /> (Area Code - Telephone Number) <br /> Sketch (Detained plans may be submitted) <br /> Se <br /> The undersigned hereby applies for permission to excavate, construct 'and/or <br /> otherwise encroach on County Highway-Right-of-Way on the Ast side -of <br /> approximately Vz- feet i -so Til <br /> of /VW y _%/ , by performing the <br /> following work (description of work) : lJ2,ej- <br /> 4f XR1SEr �, A3c��tr. R 2 a4AZ— <br /> Work will commence on or aboutfor approximately <br /> /0 days. <br /> 1, 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 /> si ture of Applicant - Title Date <br /> MASTRR.PS\FRRS®L (6/00) <br />