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08/03/2010 15:0'22 18 BYER PAGE 62/06 <br /> APPUCATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> u ,S 1 O/O OFFICE USE ONLY <br /> mate <br /> ljosg <br /> REF k I <br /> 70 San Joaquin County <br /> pepartment f Qubiic Works <br /> APN CRS <br /> 1i1t,- 0 14 CICA--S : l EXP.DATE ® DRIVEWAYS it <br /> SI�ls /a/1/ 'j rr�(�rG .. .L�- I VALID �� t� !y(Applicant Name) STREET � <br /> AREA "`�T�G�G'70 QiJAO <br /> 0 TYPE <br /> (Mailing Address) FORMS <br /> NOTES <br /> (City.State,Zip Cotte) •.�. - <br /> i <br /> -- -- <br /> (Area Code•Telephone Number) -- <br /> DaAl <br /> Sketch(�eta'sfed Atan9 may be submitted} <br /> AL <br /> I <br /> 4 <br /> i <br /> The undar5i ned hereby applies it;permission to excavate.construct andlor otherwise encroach on County Highway Right-of-Way on <br /> the- side of ItVt-•-Alf— �*approximately �c�+� seetlra►fe <br /> �� !'✓�� <br /> _ i <br /> 14-- <br /> by performing the following work desCnptign of work) <br /> WO -tivsli commerce on dr 1 t7 about 2c� for approximately - _.�days <br /> 1,the undersigned,certify that 18M the owner of the respective properly:or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations e San Joaquin Courtyard subject to inspection and approval. <br /> -- ,A•uGufi70- 52-01c) <br /> --•-----� <br /> Sign ure F Applicant•Title Date <br /> I J I U,04W) LI L L v menti <br /> fz-s� zz.e,- 41J7 <br /> Aq, <br />