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i0 12/27/2007 09:58 2094989324 <br /> � SJCO PERMITS <br /> n0 PAGE 01/02 <br /> APPLICATION ,FOR ENCROACHMENT PERMIT <br /> PLEASE <br /> PRINT.- <br /> Date <br /> RINT;Date CI l.� – (_'/�{, <br /> V FOTE <br /> FFICE USE ONLY <br /> To; San Joaquin county Q°)5Z-zo REF # <br /> Department of Public Wor)cs <br /> s — �- -O��1.1 (" i"fir!' -08 TO 9LI-O$ DRIVEWAYS:(A.pp .ica/nt Nems) /�7�N iJ �;�. t/� ,s' L.j. J Gf QUAD SGt/ <br /> 2 81(Mailing Address) _ <br /> l <br /> (city, 8tata, Zip Code) <br /> (Area Code - Talephone Number) <br /> Sketch (Retailed plane may be submitted) <br /> ! �� � fir' C? 7 I{ �� _ t01 ? '70 <br /> �'`e �r.­,e <br /> The undersigned hereby applies for pa=isaion to excavato, construct and/or <br /> oth rwiaer_enGroach on County Highway Rigb.t-of-Way on the <br /> approximately 5 ;x"' deet/ aide o f� <br /> ' by 'performin the <br /> followin work (description of wor(k) : Q,< !, ?.x 3 Y <br /> M'_i/ <br /> Work will commence on or about _ 7 %' D�' <br /> !/ days. for aPprOXimately <br /> I, the undersigned certify that t am the owner of the respective property, or am <br /> quell-tied 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 appzovai. <br /> 41(4 <br /> gi9natuse of Applicant Title ! <br /> Date <br /> NaBiCR.rB1FEEECFIDL 16/001 <br />