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JUN-10-2009(WED) 06: 57 P. 002/003 <br /> Kx Uatc/Time AYIi-LS_zUU9IIdUI U7:h5 LU9478i974 F. UU2 <br /> 2095781974 M St..Modesto[a 08:55:32 a.m. 04-23-2909 212 <br /> APPLICATION FOR ENCROACHMM PFIWIT <br /> ' 3E P '• - <br /> Date _ .� I �' °1 0MCE USE ONL7C <br /> TO: -San Joaquin County JOB # 7 " REF # <br /> Department of Public works A7�N , _ a <br /> VALID n TQ iS d DRInBnys. <br /> (Applicant Name) STRHET On <br /> Q= IV-4 <br /> TYP£ T3a1SELGf/QGE <br /> (7da1.].irag Address) Fox" <br /> NOTE <br /> (City, State, zip Coda) <br /> (Area Code .• Telephone Number) <br /> Sketch (Detailed plasty may be submitted) <br /> The undersi.9ned hereby applies for permimgion to excavate;•construct`'and/or <br /> ot<hmvise -encroach-on Cooney-ltighway Right-off-Way on-the,t --fit-�+;T vide of <br /> N. e~t t-k w approximately2 feet/watt =__NZbJVr M4 <br /> of 1.•�U i3��O�w R•���T L+S D � - by performing the <br /> follow S work (description of work) .' , b�Q- !�►Ctiy�S 'tfc T ti� mm 11 (1,0 At LAL �.i+.. �? ae "�G. '{'1 Y SLILJsC,1G L1 1S FAyi <br /> Work wi.111 commence on or about 4 Z al- for approximately <br /> days. <br /> X, the undersigned certify that I am the owner of the reapective Property, or am <br /> qualified to represent the Owner and agrse to do the work described above in <br /> accordance with rules, regulations of San .7oaquin County and subject to <br /> inspection an 0110 1. <br /> CA^4�r•CT Aa M,,. V i s Ja S <br /> siguatux of Applicant Titla Date <br /> KU'=.v%Vzft9C=L <br />