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-7EP-16-2011 15 FROM:INDEPE-NDENT IRRIGATI 209 356 8687 TO:4689324 r <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> f OFFICE USE ONLY <br /> Date _ <br /> # llv REF# <br /> To: San J0aquln County ApH CRO <br /> Department of Public Works EXP.DATE � <br /> VAUD Lt C DRIVEWAYS: <br /> ( ! STREET <br /> AREA 4`r�tto QUAD <br /> TYPE <br /> (Mailing Addrm) FORMS <br /> � 7�� NOTES <br /> (city,Stc zip cod* <br /> . 'd ' Ira <br /> (Ares Code•T018000e Nambar} <br /> Sketch(Detailed plans may be submitted) I <br /> 1 <br /> 1 <br /> pr a � <br /> I � tot• �'�' <br /> l '' s�rev 1�✓G v n d�Y SPS <br /> �wlv Ag.d <br /> o 0 <br /> J� Norr 01' <br /> F-1 <br /> The u rsi red hereby applies for issian b eXCaVate,con»h Ct ardor otherwise encroach;0nCounly Hig Right of-Way on <br /> the __side of 1Crq , Re d approximately.,,_. ile bee by perwn*m then work ption of vmrk); <br /> 7a hoo <br /> 69w . S.X r <br /> w <br /> �,AEthc�er�- <br /> Work will commence on or about. approramate� <br /> k,the undersigned,certify that I am the owner of the respective property,or am qua!'&ed to rep reser►t the owner and agree to do the <br /> mm described above' nce with the roles and regulations of Sen Joaquin County and subod to inspection and approval. <br /> ra '�, toots <br /> EgIBlY71KW16tiann°JMCYp1iENf rQ1YTMRY•A710MDPC 101 <br />