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APPLICATTox FOR ENCROACEME,NT PERMIT <br /> PLEA$h Q xNT: <br /> Date � LJ—[1/C1,� 08FTCs' USE ONLY <br /> To: San Joaquin County 1708 #_ //00 5 RFIF # <br /> Department of Public Works APR CR # <br /> S� <br /> R". DATE y <br /> VALID. 11/9"_ TO V DRIV$97AY3: <br /> (+PPUCULt: Name) STREET _W rANAL. KLYD ' <br /> AREA - RAC- QL�,D sVJ k ---- <br /> TYP$ ..�jCS�YAT�o fJ * . <br /> (Mailing Addraea) FORMS <br /> NOTE -'—� <br /> STDG 7DAJ CA 9_52_j0-'1- <br /> (City. State, -Zip Code) <br /> 20 7- 9V3- �a28B <br /> (.Area Code - To Number) <br /> Sketch (Detailed platal may be submitted) <br /> HC— UE RL 5736X0,9 <br /> �'f PrUV i�e *wo /aHeS 110 L,,J ,c 0. ,It t, c5 ll� <br /> DVS` V�0, L.30J'P-I y\p lovtA-e, st<�.I �a.T�S O�v.C'� 1acc <br /> � urs, p P � <br /> • �ro��dQ �IP�9��� ;.� �t�. < <„�: l,a�� 5 arm �tos.�( . ���T s+,�t< lu...� o�.� -�«,,,� <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise--encroach-on •County•Highway Right-of-Ka •the S - ..5.,l.,W . erida...of . <br /> W. C/FNAL BLVz)I approximatelY feet/fit W& �T <br /> of UL%� i tsG Y A VE E X T_aJtl EU , by 3�ez€orming tbte <br /> following work (description of.work) : cXCAVATE /41 EAR7W lz-gq Ll.t/�� <br /> r6ET ALOAI& CDUAPrY ROWL:HrDF A CPC <br /> /M Ano/TicN L 2-3 i7 Z L4, 84 • T/ 0 <br /> CD f/E2S 7-,0,r Lj1A I/. <br /> Work will commence on or about for approximately <br /> 3D days. <br /> I, the undersigned cortify that I am the owner of the respective -property, or am <br /> qualified to^epresent the owner and' agree to. do the i fork described above is <br /> acco ca �yzth he rules, regulatione'of San Joaquin County and subject to <br /> inn coon anM� proval. <br /> si ature of Applicant Title nate <br /> KkRMR.p5\p1MD TL (r1001 <br />