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01.01%2008 16:40 FAX 0002 <br /> RECEIVED 06/22/2010 03:26 9167241743 JES <br /> 05/22/2919 15:26 2094689324 SJCO PERMITS PAGE 02/02 <br /> 1 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> ` PLEASE pFtINT: <br /> Date 11130=9 OFFICE USE ONLY <br /> To; San JoaNn County JOB# j. ld R # <br /> Deperp'nent of Public works APN LI ca# <br /> JSS SUIbum ATTN: Cindy Otsan VADATE 1�jD /L� <br /> VALID DRIMAY9r <br /> (Appflcant Name) STREET !it <br /> Lr.UW vxS� ,V 5 AREA QUAD <br /> B1 ok TYF 8 <br /> (M>tlling Address) FORMS <br /> >�aawle'Ass�a ' NoTEs <br /> (Clty,t3cate,Ztp Code) <br /> (Area Coda-Telephono Numbaul <br /> 'ketch(-tai-fad plans may be subm fled) <br /> $90 lrnprovamsnt plops <br /> The unde*ned hereby appllee far permb"to excavate,construct a0w otherwise w mach on County Highway F�g"Way on <br /> the C�skfe of aaot M ripotsa Rd. approximately 0-1 miles <br /> —5g— <br /> Of �rpen*•�= ru�as feafJmtle <br /> by performing the folt Wng work(descflption of work); <br /> A 24k Wat:ir Win Lina will be iatttatllcad from the intdxAOQCion Of mast HaripaeQ Rd. emd Cpi =tar Rd. <br /> down to the interapotion of pAmL mariPOG& ltd, and North Little Johnis Craik. <br /> Wank wiN cmmmenca on ar aboutae+rr , fmr approximatety xaa: days. <br /> I,the undersigned,csrtfif}r that l am the owner of the respeoM property,or Am qualiffed to represent the owner and'agree to do the <br /> work described above in 9=rdm=with the rules and NgtHaltons of San Joaquin county and sub)eotto inspection and approve{, <br /> 2 1 � <br /> signore -Title Date <br /> wvu►wwra�naroo►,anatarawrr�us�maanataoo awn <br /> r <br />