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Jul 0512,11:33a LINCOLN CENTER MARKETING 209 940-2741 p.2 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �jti�3p OFFICE USE ONLY <br /> To. San Joaquin County J08# 10005" 'REF4 <br /> Department of PuNlcWorks APN R <br /> l { j EXP.OAI E <br /> VALID r r` t 7 1jRIVEWAYS. <br /> (Appllcaist-Name) STREET f / n I'�Jl� �lit•t_ <br /> n AREA Cxs—rte QUAD EJi <br /> �Z I n CO r, l Qom ' TYPE <br /> L (MailiRgAddrm) FORMS <br /> NOTES <br /> {City;State;Zip Coda) <br /> (Area Code-Telept;one Numbor) <br /> Sketch-(DdWed plans may be submitted) � <br /> L;nf r <br /> U,*r <br /> S. <br /> LT f+ 4 me +P <br /> • L,�In <br /> The undersr ned Hereby applies far permission to excavate,construct andlor otherwise encroach on Cauoty Highway Rignt ai Way on <br /> the H Ah#_Saute sfdevf�C���a l5" n fErs(� apo=lrnawy f ,tie�� <br /> y �t4ce PaC�y A n4� ,by pi*17nlnB-1116 following.work",descrlptlan of work): <br /> bFF;cers . of ="►1:r�t1FP �— Men' J,�l� ;n(r c Gfi�04 �Q;�f <br /> Work will commence orrorabott_ 4+�`l'1 ; � #or.approxiinately <br /> 1.the urders;gred,ca-1ify that I em the owner.oT the rt pecbve pmperty,or;rz quelltled to:�epigsentthe owner and.agrftjt,do the <br /> via described abv : ca ance with;-e ales and regutations of San 10*3016 County arxf subject to inspsdion aril approval. <br /> tgnaturene'ApplicanllJs -- <br /> :.•4CR:NPYATEP.:tlRM�3M.:k�tfTmn}:(J^.r'E1COE 10'4.'1 <br />