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Mar 31 04 09: 54a <br /> Valued Customer <br /> APPLICATION FOR ENCROACMM= PERMIT <br /> PLEASE PRZN'I': <br /> Date _ 7/7,8/06 orms lass oNLY <br /> To: San Joaquin County JOB 0_ 1(005 REF # <br /> Department of Public Works APN CR # <br /> CHEVRON T EXP. DATE <br /> �� L11V,E' �. <br /> VALID /3 LG TO /O / DRxV=kYS: <br /> (Applicant Nam) STREET QLT&T I_IAiE, Foq� <br /> 23too BucHA Afq/V MCO D AREA- zAcy QUAD -- <br /> _ TYPE _$Eur tlot es t <br /> (Sailing Addreae) FORMS <br /> PiTiTeaRG • CA 9yr6S NOTE <br /> (city, state, Zip Code) <br /> 9Z5- 7:53 -2ob�f- <br /> (Axoa" Code - Telephone lumber) <br /> Sketch (Detai)ed plana mmy be submitted) <br /> 5��' An-AG�IMEN� • <br /> S SIT <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwis encroach on County Highway Right-of-Way-nn.the N ORT14. Aide.of <br /> r - <br /> PJ'r UNE RoAo ap�zoxirnately feet/mile <br /> ,., &m JkAU . at-hr AND SYRQ� L{iGNWAy bye Y€arming the <br /> following work (description of work) : I . <br /> AMOMALI 'r IN �;o,�s <br /> AREA R0 -' <br /> EANIrAL- <br /> Work will commence on or about AVC-JU1r-L4 for approximately <br /> 1 d <br /> days. <br /> I, the undersigned certify that 1 am the owner of the respective property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> aet,ordaneo with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval~ <br /> ,Signature of Applicant 4csbtle Date <br /> MUM-DAnnomL fi/00) <br />