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APPLICATION rOR RNCROACBMNT PXRXI ' <br /> Date 1/25/01 OFrXCE 992 ONLY <br /> TO: Satz Joaquin County JOS # t®O 5 _ RRA' 0 - . <br /> Department of Public works AFN CR' # <br /> EXP. 1]iiz �!- <br /> y Yj �r ¢irtps� VALYD TO Invi yo I <br /> (Applicaut woze) STREET <br /> ARS L;g1r. a <br /> E. &M Ined TYPE 8 <br /> ��... (mailing Addrese) FORMS .SS <br /> NOTS <br /> Wocdlgnd,. CA 95Z&= <br /> (City. State. Zip Code) <br /> (Area.C*de - TOIsPheue Number) <br /> Sketch (Detailed plan may be submitted) <br /> I l <br /> Mw %n Jcee u 03. Ht� t pC'dt �� ftr t�1e Gegrabe bo 3 <br /> C2) w4 mbseq w t tr nll we71 Mei ig C12 <br /> The undersigned hereby applies for permission to4eXC&V&te, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the aide of <br /> `Q ri y _ approximately — ae /mile <br /> Of y performing the <br /> following work (description of work) : <br /> 80 <br /> ' Wth <br /> Work will Commence on or about ! for, approximately <br /> - days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represant the owner and agree to do the work described ab va in <br /> accordance with the rules, regulations of Satz Joaquin county and subject to <br /> inspection and approval.. <br /> Z2. 21,!nel- <br /> Si2uature o! p Iia t Title Da <br /> �Z'ok,��tilaBd�L f6/gyp/say <br /> TT/E'd EG20-299-0ES-393M-'9N3-035`1S3M 9E:ST TO, ET Had <br />