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APPLICATION FOR ENCROACEXOM PERMIT <br /> Date <br /> 11/25/01 Or?XCX van ONLY <br /> To: San soaquin County TOB ! f•Q45_ REP # <br /> Department of public 'Works APN CR' # <br /> EXP, DATE q-191— d <br /> 4,�9t�ern Geo- fns _ VALID 7- TO <br /> (Applia=t name) STUBT _M.iSsign Ave • � <br /> "im Qt= + <br /> 1386 E -II�t street -- ` <br /> (x%i.lin+g Address) FORMS <br /> NOTA e� <br /> vtmliaid, CA 957��3 <br /> (City. State, sip Cade) <br /> (Aarea. 'Code -,Telephoae Number) <br /> Sketch (Detailed plana may be submitted) <br /> ' <br /> See Attadvd F.Z es <br /> NOTE: The Sari Joaquin County tYivironmental Health Department permit for the <br /> Ge6probe borings (TPH3) and subsequent monitor well MW7 is SROD24869 <br /> The tmdersigned hereby applies for permission to excavate, censtruet and/or <br /> othsrwiss en!crooch on Couaaty Highway Right-ot-W�ey on the -side of <br /> x Approximately � 1� ea mile <br /> of . i3ltd. orad Minimkre. , erforming the <br /> following work (description of work) c t. tru�mcu'Sted ) adv=e <br /> fW mM2 of ;roper lccaticn <br /> in a 110 == 20' SWth of the intersectim = erz <br /> at..a..pc�in*_ irnt;ter. wiith rT ti•w Ir�t T--mUm, 11 tss� rnles will to destroyed with ��xzt Hast cx+ms�t ��d 5% <br /> Work wall commence on or about XuL ' z 4 a for approximately <br /> days. <br /> I, the undersigned certify that I am the owner of the respective property, or aeh <br /> -lualified to' 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 /> erection and approval. <br /> 11itd0kture of lican - Aritle Dat <br /> ��'��lICS6CmL 1 /70/004 <br /> TT/21'd EL20-299-OES--393M-'9N3-03911S3M 8E:ST TO, ET 83.E <br />