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SE -08-HIO(WED) 09: 20 P. 00210031 <br /> nx uaic/ IlML Ut: .. LV7:101't11 r, Lmz <br /> 20SM1974 M 5t..�dodesta Ca 08:55:32 a.m. 04-23-2409 212 <br /> APPLICATION FOR ENCROAC MNT PERMIT <br /> PLEASE"PR nax <br /> Date - `✓ ` {' OR710E USE ONLY <br /> To. San Joacuin County uo8 # ��` � � REF # <br /> Departme:t of Public works ;WN Czr �$ <br /> EXP. D <br /> �� VALID / d DR2Vn'WS r <br /> (,Applicant Nance} STREET « <br /> AREAZvAken QUAD /1lF w <br /> TYPE Et'G9V ln�C � d� <br /> (Mailing Address) <br /> �'�a4 Tai- ► {1CJt� l a ISOTE <br /> (city, stag, Zip Code) <br /> (Ares Cade - Telephone Number) <br /> Sketch (Detailed plan* may be Submitted) <br /> tted) _ p <br /> i <br /> { <br /> • S! <br /> The undersigned hereby applies for permission to excavate; Mkst-Mat`'and/or <br /> - othexw.i.se -encroach-on County., -Might-of-Way on the --- ..3"; side -of <br /> approximately feet,46ls , Es1.�T <br /> of E Ott by performing the <br /> following work (descriptiazs of work) ; Q:XF_^-1_ 0%rt A"*0 t e-xza-4�L Q*> <br /> Work will comsaeace on or about _ ��t ��i �•t for approximately <br /> days. <br /> I, the undersigned certify that I am the owner o the re;5pective property, or am <br /> qualified to represent the owner and agree to do he work described above im <br /> aceorda=ce with the riles, regulations of San Joaquin County and subject to <br /> inspection and, a <br /> � �xYlea <br /> Signa ura-O—tcArsdicant - Title Date <br /> x�:mc_asttRtisCo:, tc/ao� <br />