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JUN-08-2009(MON) 13: 16 P. 002/005 <br /> Kx Jate/Time APtl-7.1-LUU9f7'HU) U7:55 ZU957UI974 F. UO2 <br /> 2095781974 M St..Modesto Ca 08:55:32 a.m. 04-23-2009 2/2 <br /> APPLICATION FOR ENCROACSM NT PERMIT <br /> PLEASE PR <br /> Date - G� C �^'�"� O"XC$ USE* ONLY <br /> To; 'San Joaquin County JOB #13O'?q- <br /> Department of Public Works ABR C17 # <br /> ►'�s�7 <br /> EXP, DAM •01 <br /> VALID •10.09 TO _� _1_•0`? DR 7ZWI►Y8: <br /> (Apel .cant Names) <br /> `L�u C, �.. Y1►1,e (�Ja.l� Typz dDEi St0.aYeJ �i C�� - <br /> (Mailing Address) FORMS <br /> S�>alt�_,,�, e-p. '�s`�,►� �ror� <br /> (City, Stage. Zip Coda) <br /> (Area Coda •- Telephone Number) <br /> Sketch Metailed plana may be submitted) - -� 5O.— <br /> Sc.a A77�t..1kC+� - <br /> The undersigned hereby applies for permission to excavatei• coxwtruct `and/or <br /> otherwise encroach•on county-Highway Right-of-way C.P -ths' _., .5`04T—M ..' -side -of <br /> K� 's-1 -0C 1 V a 5 approximately (.� feet./aloe, EAST <br /> of — A�, Cr A _. amu:,,Q,L,Q - by peztorming the <br /> following work (dcacr3ption of work) : ti�4 l �+. l•1 L' 1-�b(r moi- 5 O wM L k <br /> E1FAgri DtG Cry S?L.%r _r ►ate <br /> Work will commence on or about YG >R for approximately <br /> �7 aayu. <br /> I, the undersigned certify that 2 am the owner of the respective property, or am <br /> qualified to repres the owner and agree to do the work described above in <br /> accordance with es, regulations of San Joaquin County and subject: to <br /> inspection an p o 1. <br /> Cal•�C•�"t M-0,11 k W <br /> Signature of Applicant - Title Data <br /> �'TEk.AB�7YYSC1my IBIOOI <br />