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r?Of^ :CHL I FOFN I H I;.IHTER SERs:!1 C:E FAX NO. :2094640195 Jun. 1" 010 10:F-FArl P <br /> APPLICATION FOR ENCROACMMN'T 7PMWIT <br /> kASE PRINT" <br /> Date 11 S!10 OFFICE USE ONLY <br /> TO: San ,7oaquin County JOE 73,!w 7 _ &EF # <br /> Department of Public Corks APN Cit # <br /> • E�. pA.7(� <br /> vAL33 . DRIV YS: <br /> {ApPliaaat Name) Smum /Gf <br /> ASA `QUAD? <br /> T"Y"PE <br /> may, Mailings Addroga) FORMS <br /> (City, State, -Up Code) <br /> (Are& Code - Telep3sone Number). <br /> Sketch (Detailed plass may be sisbmitted) <br /> SEF MIP1TT1f� <br /> The undersigned hereby applies for permission to,excavate, c�,,��cc rust and/or <br /> �8e� c oxl •Couuty•H.ghway Wight-of.-y�v:•oa•the I .. ' ' t,... •_' . <br /> approximately ` (�_ ee Jmile <br /> of ` - <br /> '•+. . , by peYf axtni�dg the . <br /> fox7�owia work <br /> (description o€;mork) ; }{ 1K J��1NA j2(7= 7j <br /> 1 ENIFJeG� NCY <br /> WO-Ir will commenceon or'aboutyTu a01C� for approximately <br /> G days. ' <br /> I, the undersigned certify, that: I am the owner of.the respective property, or am <br /> gUalif led to represent the owner and agree to do the Tioxk described above in <br /> accordance with the rules, regulations'of San Joic 'C6 ty and subject to <br /> inspection and approvai. <br /> Va <br /> llmuw_13�1_ 7 - - <br /> S tore o� A lS/l5�IQ. <br /> App ic=t Tit3.e Ante <br />