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UL-Id-2ii10(WEO 13: ELI ii F 002:'00; <br /> Hx Date/'rime ANR-Ii-GUUYV HU) U7'55 1095781974 V. UU•L <br /> 2095767974 M St.,Modesto Ca ea:55:32 a.m. 04-23-20Q9 212 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE P <br /> Date i f -Z OFMCZ ass ONLY <br /> To. 'San Joaquin CountyJOB # <br /> Department of Public works APR C # <br /> EXP. D Ca <br /> VALID 10 10 TO /d DR=4Hi�AYB: <br /> (Applicant Name) STREET ,Fid-' �'}: r <br /> [TAD <br /> 'l TXPE O� LF �oYd�� <br /> Nailing address) FORMS <br /> NOTE <br /> tats, state, zip coda <br /> (Area Cada - TalephoneNumber) <br /> Sketch fDetailed plans may be submitted) <br /> <; t CL <br /> The undersigned hereby applies .for permission to excavate;- construct 'artd/or <br /> - otherwise vncroach-on Count:y,H ghway-i�i.ght-of-way on--the•-• - -z-T�h -aide -of <br /> approximately <br /> of �is i�c.t�.cr7' . '+�t�-faj,� vvao►���-%v l,_. <br /> fox_xowing work (description of work) : ¢,ALttias� A- q,% 6` `Y Zy�p(- C'4-t - sg the <br /> Stork sill commence on or about t� for approximately <br /> `4 days. <br /> 1, the =de=signed certify that Z am the owner of the respective property, or am <br /> qualified to represent the owner and agxee to do the work described above in <br /> accordance with :.he e, r gulati.ons of San Joaquin County and subject to <br /> inspection and =Val. <br /> Signature of Applicant - Title <br /> Data <br /> MUr-1 t.P8XrK3R=z (4/00) <br />