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APPLIGAAWFOR ENCROACHMENT PERMIT <br />PLEASE <br />Date C�dy <br />To: San Joaquin county <br />Depanlirentof Publioworlks <br />Cow AIEP6'-;R_mQC <br />(Applfean@ blarrie) <br />(MailingAgdms) <br />(CRY, gtatc, Zip We) <br />(Avea Coda -Telephom Number) <br />Tho underslgnedhereby approsfor perallsslontomavato cgnshucfandforotherMseencroachort County Higi1Way%ht-of-Wayon . <br />the�rkh sidear" E We�Ps •��e, apptvxifnato(y; X59 feoUm(e,aS�' <br />by Perrarnung theiollowing work (description of worfg: <br />Illiorkd[lcommanceanorabout 5- - farapprozimafely 40 days. . <br />L the undersigned, wiltfyfhat l amthe owner of the rospedive property, oram qualified to representtha ownerand.agree to. da the <br />uuorkdescribedaboveinaccordancewithfherulesandregulationso'rSanJoaquinCouni and subjdotfoinspectionand approval. <br />/L- ,os Gefk <br />ftanaxnre of Ahplkant rim <br />�1�EKIPAffiFkVICESCI&llepLWILtSV.Wt1Ag51E4PSL�I;GROpCN,1E7iEPfAd!ffAPP/lCgil0tlW0 1o9113f <br />5--1 a '. ' <br />Data <br />OFFICE USE ONLY <br />JOB>i9'. <br />730077 }EFS <br />APN <br />OR4r <br />EXP. DATE <br />8%01/2020 <br />VALID - <br />' 5/21/2020 TO 8/01 /2020 DRIVEWAYR ' <br />SIREN <br />WEBER AVE. <br />AREA <br />STKN' QUAD ES <br />TYPE <br />BELL HOLE. <br />FORMS <br />,SSNWV R-29 •Trench Cut .Policy <br />NOTES <br />SPECIAL CONDITIONS . <br />*****EMERGENCY WORK***** <br />Tho underslgnedhereby approsfor perallsslontomavato cgnshucfandforotherMseencroachort County Higi1Way%ht-of-Wayon . <br />the�rkh sidear" E We�Ps •��e, apptvxifnato(y; X59 feoUm(e,aS�' <br />by Perrarnung theiollowing work (description of worfg: <br />Illiorkd[lcommanceanorabout 5- - farapprozimafely 40 days. . <br />L the undersigned, wiltfyfhat l amthe owner of the rospedive property, oram qualified to representtha ownerand.agree to. da the <br />uuorkdescribedaboveinaccordancewithfherulesandregulationso'rSanJoaquinCouni and subjdotfoinspectionand approval. <br />/L- ,os Gefk <br />ftanaxnre of Ahplkant rim <br />�1�EKIPAffiFkVICESCI&llepLWILtSV.Wt1Ag51E4PSL�I;GROpCN,1E7iEPfAd!ffAPP/lCgil0tlW0 1o9113f <br />5--1 a '. ' <br />Data <br />