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APPLICATION FOR ENCROACHMENT PERMIT <br />1701XPOOR i 1N1111r <br />Date 11 /25/19 <br />To: San Joaquin County <br />Department of Public Works <br />Lasar z:1 Construction Inc <br />(Applicant Name) <br />2625 N Sunnyside Ave <br />(Mailing Address) <br />Fresno, CA 93727 <br />(City, State, Zip Code) <br />Luke Ruby 559-291-1024 <br />(Area Code -Telephone Numb <br />er) <br />luker@lasarunderground.com <br />(Email Address) <br />Sketch (Detailed plans may be submitted) <br />SEE ATTACHED <br />OFFICE USE ONLY <br />JOB # REF # <br />APN CR # <br />EXP. DATE <br />VALID TO DRIVEWAYS: <br />STREET <br />AREA QUAD <br />TYPE <br />FORMS <br />NOTES <br />Additional Contact: Luis Ordaz 209-400-7074 luisordaz.cityrise@gmail.com <br />The undersiynetl hereby applies for permission to excavate, <br />the North side of _Guernsey Ave <br />construct Al otherwise encroach on County Hi Ri <br />of Grey Fox PIght-of-Way on <br />approximately � 90' feet/ ile West <br />by performing the following work escription of work): <br />Work will commence on or after 1 /6/20 for approximately <br />days. <br />I, the undersigned, certifjr that I am the owner of the respective property, or am qualified to represent tl�e owner and agree to tlo the <br />work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />Y:IEORA7S & TEMPLATESIENCROACHMENT PEPfdl7 APPLICATION.dcc (OWOB) <br />'I 1 /25/19 <br />Date <br />