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RUG-13-2012(MON) 11 : 40 P. 002/003 <br /> IIA. u46CI11me Brit-ii-Iuv7llnuI Uf; 77 Lu93181ylK ('- UtlL <br /> 2095781974 M St..Modesto Ca 08:55:32 a.m. 04-23-2009 212 <br /> APPLICATION FOR ENCROACMMNT PERMIT <br /> PS <br /> FLEAS_ P3rNT: <br /> Date ✓ I O1tFIC1>C D$8 ODtLY <br /> To- -Sass Joaquin County a7m # REp #' <br /> Udpartment of Public Works APN CR' # <br /> �. DA <br /> /V _ VALZD TO DRI4mwo; <br /> (Applicant Name) STREET CIA + <br /> t_ ARBA QLtJ1D <br /> 14 mite R,/ TYPE <br /> (Mailing Address) FARMS <br /> �f TC,l1 <br /> (City. State. Zip Code) <br /> (Area Code - Tel,ephone bb—her) -- - - <br /> Sketch (Detailed plans may be submitted) <br /> �1�. � �.'1��CK�� oi'A'L✓•w� <br /> The undersigned hereby applies for permission to excavate;­ construct •and/or <br /> - <br /> otherwise •encroach o Gaunt Highway-Right-of-Way on-tbe w a/7� �� aido of <br /> .�•1, �♦•� Q• approximately <br /> of . by performing the <br /> followin kk (description of work) ; <br /> f. `isuse Ie7 Ar. a Jr egg,« ce&v,ee <br /> Work will commence on or about - - for approximately <br /> days. <br /> 1, the undersigned certify that Y am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to . <br /> inspection and approval. <br /> ,,8' atuzre of Applicant - Title `� Data <br /> lwar�.atlrsaacaoa. lcfaal <br />