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2095781974 M St.,Modesto Ca OT,21:25 a.m. 06-16--2008 2,3 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date U tY�t/ y _ OFFICE USE ONLY <br /> To: San Joaquin County JOB # t1 " V( REF # <br /> Department of Public Works APN CR" <br /> EXP. DATEa7 <br /> VALID }7'f- TO <br /> .r;"-c DRIVEWAYS: <br /> (Applicant Name) STREET , 9.� �'• _ <br /> AREA Tr'tit 5/' 4L7AI} <br /> ,�! ^1 <br /> 1` low, 'PE <br /> (Mailing Address) FORMS <br /> NOTE <br /> D�SID qs�6 _ <br /> (City, State, Zip Code) <br /> (Area Code - Tele: hone Number) <br /> Sketch (Detailed plans may be submitted) <br /> 41 <br /> The undersigned hereby applies for permission to excavate, onst ct and/or <br /> /qthel7wise e on County Highway Right-of-Way on the side of - <br /> 1 21Ce' approximately 1 feet mile _ <br /> of by performing th <br /> }^following <br /> "o l wing� <br /> nwork (description of work) : I i es <br /> (J4�'tom►kow8iq TD n <br /> Work will commence on or about for approximately <br /> days. <br /> I, the undersigned certify that 1 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 /> �atu of Applicant itle Date' <br /> I <br /> t <br /> HA-"TSA.FS\Y3RS0ZL f6/0,1; <br />