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APPLIGABON FAR ENCROACHMENT PERMIT <br />�LEASS Pe�[NTa <br />Date <br />To: San Joaquin county <br />Department of Public Works <br />(`c �i'��n�rA VVAiEJz,MU[e,E <br />(Applicant Marta) <br />(Malting Odress) <br />(City, State, Zip Code) <br />%091 4V (-Y 31 1 <br />(Am Code Telephone Number) <br />6199 <br />Theunders[gnedheFehyappliesforpemtiss[ontoexcavat0,cgns[ructandlgrofiheiwiseencroacfi,onGounfyYiigti RightofWa un <br />the EmSj- sideof �rnn�u,nP:{--1-', !n apprgximately_ O ee i(e IV + <br />of,FunS�an sv2 �— hyp0rfonningthefoliowingwork ddpt[onof, Wodc): <br />Woricwil(commencegnorahout -2�c�i�.l9. forapproximateiy days.. <br />I, the undersigned, certifythat I am the owner oftherespedtvo properly, or am quall$ed to representthe owner and agree to do.the- <br />vugrk described above in accordance with the mles and regulations of San Joaquin County and subjeetto inspection and approval. <br />110EllIPNSERYCESNAHdOP1WB8V.WMAA51�lt�ICftOACNUflRPfPb4fAPPIkAit0;L000 @A'I1J <br />'Dat® <br />OFFICE USE ONLY <br />JOB# <br />�f, j�f REF# <br />APN <br />CR# <br />EXP. DATE <br />51j90 <br />VALID <br />/a T 5 / 10' DRIVEWAYS: <br />STREET <br />ARCA <br />QUAD ArV <br />TYPEo <br />S . <br />FORMS <br />-29 S v✓{'%dc,✓dYL�vJ�1tl�Gj! <br />NOTES <br />zw!r . <br />Theunders[gnedheFehyappliesforpemtiss[ontoexcavat0,cgns[ructandlgrofiheiwiseencroacfi,onGounfyYiigti RightofWa un <br />the EmSj- sideof �rnn�u,nP:{--1-', !n apprgximately_ O ee i(e IV + <br />of,FunS�an sv2 �— hyp0rfonningthefoliowingwork ddpt[onof, Wodc): <br />Woricwil(commencegnorahout -2�c�i�.l9. forapproximateiy days.. <br />I, the undersigned, certifythat I am the owner oftherespedtvo properly, or am quall$ed to representthe owner and agree to do.the- <br />vugrk described above in accordance with the mles and regulations of San Joaquin County and subjeetto inspection and approval. <br />110EllIPNSERYCESNAHdOP1WB8V.WMAA51�lt�ICftOACNUflRPfPb4fAPPIkAit0;L000 @A'I1J <br />'Dat® <br />