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Jul. 17 -IC00. <br /> APPL1CA' 101 Pop' ENCRO.ACMaNT PERMIT <br /> PLEASE-PRINT <br /> �� t <br /> Date 'A2)4 � <br /> oFPxcE IIsi ONLY <br /> TO: San Joaquin County +77�C�77 REP <br /> Department of Publ=c Works 01008 <br /> cl <br /> EXP. DATE le-To fo- <br /> (ApPlicant Name) STPMT el-I <br /> TYPEL <br /> mailing Addroaa} PoRbS 2-Z9 <br /> I ,�,,�, NOTE <br /> (C3ty, state, .UP Code) <br /> (Area code - Telephone Vurnber). <br /> Sketch (Detailed plan may be avbtnxtted) <br /> The undersigned hereby,appl,ias for <br /> otherwise--encroach•on -count y :Ripermission to.excavate, <br /> Y 8xghwaRconstruct and/or <br /> ght•-of-way,oaithe <br /> of F'F'ti\ aPPrOximately <br /> following work (desCrj�ytion nf:wor3t) : ' by performing the <br /> ------------------ <br /> Work wall commence. On. or,about <br /> clays. .� for approximately <br /> the undersigned certify that x am the owaex of,the respective 'Property,qualified to represent the owner ,asci a P P y, or am <br /> accordance with the rule wee to do the work described above in <br /> inspection and approval, xegzi7 atians 'of San soaquiz3 County and 8Ubj ect to <br /> �O'�'-ib'-443 <br /> Sisnatire of Applicant <br /> acr.asitias®: Date <br />