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/25/2006 WED 14:38 FAX 2094682999 SJC PUBLIC WORKSJDO1/001 <br /> .MSS <br /> APPLICATION POR ENCROACHMENT PERMIT <br /> PLEASE Pann, <br /> Date ��06 <br /> OFFICE. II58 ONLY <br /> To: San Joaquin County JOB # 00 S REF # <br /> Department of Public Works APN CR # <br /> iG O'k� ��✓�• <br /> EXP. DA 41E�- j <br /> O <br /> VALID ITo O DRIVEWAYS <br /> (Applicant Name) STREET E Z ELI/ <br /> O. �X �/9/ ARRA L01>1 QUAD N E { <br /> TYPE -EPAr-, Flo Sy (a•C <br /> (mailing Address) PORMS <br /> /UG S 7Z (^/7 l�3.5� NOTE <br /> (City, State, Zig Code) <br /> (Area Code - Telephone Number) <br /> i <br /> Sketch (Detailed plazas may be submitted) <br /> BRuella(�Q <br /> I <br /> The undersigned hereby applies for <br /> co tract alrff <br /> otherwise encroach on County•Highway Right-of-Way-on-Che s'ide._of <br /> aPproximatelY . feet./mile <br /> of by`performing the <br /> fo lowing wor),,(description o£, work) : V1 <br /> /10- G J�so�7 <br /> 0' <br /> Work ill o mmence on orabout for <br /> /a -1 <br /> days. Arr approximatelyA <br /> ft <br /> 5ipry s�n� <br /> 1, .the .UnderSigned certify that I am the owner of. the respective property, or am <br /> qualified to represent. the owner and .ag-ree to. do .the work described above in <br /> accordance with the z•ules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Signature of .AppliaaAt Tit1® Date <br /> PASTER.PH\PY3SCi�L (6/00) <br />