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e <br /> Y <br /> C N <br /> FOR ENCROACE2,a r P$RMI . .. <br /> `P <br /> L <br /> O <br /> AP . <br /> PLEASE PRI ., <br /> ONLY <br /> /zo .. 08FYG8 <br /> Date !/ REP # <br /> County JOB n <br /> To: San Joaquin ° CR' <br /> APN <br /> Department of Public Works EXP. DATE S-/ :^ -61 DRIVXWAYS: <br /> �Se�'rI rIt-G�' VALID <br /> (Applicant ame) STREET 1�S�S/ <br /> c� / AREA PTTd�/ 4: t,.��u. • <br /> lJ�l co =E TO <br /> /Ytoit/l 12 _ <br /> (Mailing Address) FORMS <br /> 5J i rt✓ 4 . <br /> NOTE <br /> (City, State, zip Code) <br /> i; <br /> (Area Code - Telephone Number) <br /> h Detailed plans may be submitted) r <br /> Skec ( <br /> t <br /> t <br /> /t/o �� ' Tie sa H .1°'G�ru •h44 <br /> �e� /� ���'`• �'n'•% �` fin"' :, <br /> St <br /> Y4t. <br /> e <br /> The undersigned hereby applies for permission to excavate, co ct and/or E <br /> side of <br /> otherwise 'Iencroach on County Highway Right-of-way on the �r Cl <br /> ,p approximately fey mile <br /> of v' O .' hy! y performing the' <br /> followingwork (descri tion of work) : <br /> p �re.7t <br /> r ter `' IA94-G7�i0'7 <br /> r <br /> 1 <br /> Work wills'commence on or about adDO for. approximately <br /> days. <br /> i <br /> 1, the undersigned certify that I am the owner of the respective property, or am <br /> qualifiedjto represent the owner and agree to do the work described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> PLO O <br /> Signature of A lican Title Da e i <br /> ''"T".PAFE--L (6/30/001 <br /> L <br /> w <br />