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I. <br /> ;FF'-'; a-�U' Lif i UF. i 5' 11G M={F;F ?; =0'�i 4,,P, AJM i N i 5A:} ;i?cG952t1Q8p ? ��{ I <br /> 2/OC31 <br /> APPLICATION FOR EN'CROACM= PERMIT <br /> PLEASE PRINT: <br /> Date —1.z+—j D OFFICE IISS ONLY <br /> To: 'San C'oaqui~ County J013 <br /> Department of Public Warks APN CR. <br /> LT <br /> r EXP. DA2 _ VALID 2✓ o TO Det AYS <br /> (Applicant Name) STREETiIN <br /> A.32FA 15--Q-' Y° QUAD <br /> =!Y <br /> (Mailing Address) PORMS <br /> NCTE <br /> (City, State, Zip Code) <br /> (Area Code Telephone Number) -- <br /> sketch (Detailed plans ira.v be submitted) <br /> Al <br /> s — <br /> The undersigned hereby applies for permission to excavates construct `and./c,r <br /> ouhe---wise encroach on County -R-i:ghway--Right-oto ay on the W ga side -of <br /> approximatelyd e /mile <br /> + by Perfo rg the <br /> following work {descra.ption of work) M GFS t <br /> Work 11 commence on or about 19 /G3 for appwoximate y <br /> j days. <br /> i, the undersigned certify that T_ am the owner of the respective property, or am <br /> n <br /> gualified to represent "he owner and agree to do the work described above : <br /> accordance with the rales, regulations of San - oaquin County and subJect to <br /> i specticn and approval. <br /> Y_ <br /> .ature o Applicant - Title Date <br /> PUS:"ER-De�asBERWL (G/Ool <br />