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FROM :CALIFORNIA IJATEP SEROICE FAX NO. :2094640195 Apr. O3 2069 01:41PM P 2 <br /> APPLICATION 8011 ENCROACMCNT PERMIT <br /> PLkZ•}�SE PRINT: . <br /> Date 1� � { O"XCE IIS3 ONLY <br /> To: San Joaquin County JOB # '• D17 RLF # <br /> Department of Public: Works ApN <br /> EU. DATE <br /> {App33.caaxt Name) S7CRM 61&6&M� *�AYs <br /> AREA QUAD <br /> Mailing 7 yps A•z( Gr <br /> g A.ddr�ss) FORMS ��- <br /> 5 ns 7•Qz) NOS <br /> (city, state, .Zip code) <br /> (Area Code - Telcphone Reber), <br /> Sketch (Detailed ilans may be submitted) <br /> z FM <br /> The undersigned he applies for permission to.excava�te, aoxestxuct and/or <br /> othexv se-encroach oa unty.gighway Right-of-�Pa •-oa the ' <br /> �SAt�I�.0 l N SCC' <br /> of appxoximatel gyp _ <br /> Y <br /> following f work des �Gx'iption of,work) .• ` , by PexfoxMilig the <br /> _,;• <br /> Work will commence on ox'abouts^t l�34ao <br /> loCl <br /> days-• for approximately <br /> r, the ed tos 9nedepre certify that I am the owner' of.the respective-property', or am <br /> qualified to represept the oWner and agreE to do fie'i�oxk descri)sed above Ftp <br /> accordance with the rote reglilatiox�s'of San Jos <br /> inspectiou and approves , q�� Gaunty and svb�ect to <br /> � •IWC 1�A� - t1��R1`I� •�• ' C r R•� • ' � � . <br /> Sigmatura Of APPlicant - Txtje <br /> Date <br /> 1�t�c.pr\ ¢. tc/ooh • ... <br /> 1 <br />