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OCT-22-2009 15:27 From: <br /> Tu:2094E89324 P.2,4 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLFAS— Tr' <br /> Date ��p} <br /> OFFICE USE ONLY <br /> To: San Joaquin County <br /> Department of Public Works JOB �� REF# <br /> APN CR# <br /> EXP.DAi'E <br /> (A. 11cant Name �'a"`--�-� VALID 1•t TO 2•,b, <br /> �1 � STREET ��P2�SS DRIVEWAYS; <br /> AREA t 5 v0 QUAD <br /> (Halling Address) TYPE <br /> FORMS <br /> /q � S'•,��� NOTES <br /> (City,State,Zip Coda) <br /> X39 - 0 33 4 <br /> (Area Code•Telephone Number) <br /> Sketch(Detailed pians may be submitted) <br /> sed <br /> The undarsignod hereby appfles for permission toe vete,instruct and/or otherwise encroach on un Highway the side of C� <br /> of —" approximately , >y g way fight oof ay�n <br /> by performing the fodiauvin feet/mile� <br /> a <br /> A work(description of work): <br /> � e <br /> Work will commence on or about <br /> R for ap roxl tely �© <br /> I,the undersigned,cettify that i am the owner of the respective property,or am quaihled to days, • <br /> work described above In accordance with the tutee and regulations of San Joaquin County and subject topes owner <br /> agree to do the , <br /> P and approval <br /> nature ofARpil�nt•Tltle � Qg <br /> awe.��.,vxwuma.�u+�aw,w,r,�r�►n.�naoo�,c,n, date <br />