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23:a9 12095996504 COLOR THE SKIES <br /> PAGE 01103 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /fry/ err <br /> OFFICE USE ONLY �� <br /> To: San Joaquin County <br /> Department of Public Works JOB# <br /> APN <br /> (_•�fi�" Js �S EXP.DATE <br /> -;e- VALID <br /> (Applicant Nettle) TO �.S• l as D IVEWAYS: f <br /> STREET L`Go.,�Ttr.V �-,y �1/E <br /> i <br /> AREA ,%'.Oe — QUAD <br /> (MailingAddress) I TYPE <br /> FORMS <br /> NOTES <br /> (City,State,Zip Code) <br /> ��L4�1104'ee <br /> - <br /> (Area Code-Telephone Number) <br /> i <br /> Sketch(Detailed pians may be submitted) <br /> I <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County the side of <br /> of my Highway Right-Of <br /> approximately feet/mile_y on <br /> by performing the following work(description of work): <br /> L ✓ r7�r~ <br /> Work will commence on or about <br /> !, the undersigned,serf" ^� for approximately <br /> pry that I am the owner of the respective proda <br /> W0 escn 1 d above in accordance with the rule3 and regulations of San Joaquin County and subjectr, owner n ^ 9. <br /> Property,or am qualified to represent the owner and agree to d°the <br /> to inspection and approval. <br /> Signature of Applicant-Title <br /> 6,�V&dv.p'n�STCK.'5EdiCitCACnyEM FERtM7AG <br /> Date <br /> 'LGATCf.00C 19,98) <br />