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M 12/27/2007 09:5^0 2094689324 SJCO PERMITS PAGE 01/02 <br /> ■ <br /> ■ APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE -PRINT: <br /> Date r` F j p y OFFICE USE ONLY <br /> To: San Joaquin County JOB # ;z;40—V'010 REF <br /> Department of Public Works APN CR' <br /> EXP. DATE <br /> VALID TO /-' DRIVEWAYS: <br /> (Applicant Name) STREBx <br /> AREA -- QUAD <br /> TYPE <br /> (Maili (( /Address) {r FORMS �Z <br /> � 5� � J7V NOTE <br /> (City, State, Zip Code) <br /> (Area 'dodo - Telephone Number) <br /> Sketch (Detailed plazas may be submitted) <br /> The undersigned hereby applies for permission to excavate, onstruct and/or <br /> ot4herwiae cr h n; County Highway Right-of-way on the � side of <br /> �v' approximately % �% . et mile <br /> of P by 'pe'r€orming the <br /> following work (description of work),: <br /> i <br /> 4. <br /> f <br /> Work will commence on or about for approximately <br /> days. <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 /> S gnatura o �Ap lic nt - Titl / / Date <br /> IM8TER-F3\F9C8C'EDL f6/001 <br />