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FROM ENVIRONEERING INC FAX NO . 9258389621 - Jun . 08 2007 09 : 57AM P3 <br /> i <br />:J <br /> ij <br /> APpi, iCATION FOR ENCROACHMENT PERMIT <br /> i <br /> PLEASE PRINT : <br />! OFFICE USE ONLY <br /> f Date � /l O D <br /> To % San Joaquin County JOB #,J/1G6� - CIRF # <br /> Department of Public Works APN CR' # <br /> C41 , EXP . DAZE 5 / 5-07 <br /> /` UYI7 / 4 Th Li L/ O .OY �/G . VALID <br /> S^ � o� TO S /S^ o7 DRIVEWAXS : <br /> (Applicant Name ) STREET -E4- <br /> AREA <br /> GAREA STO=".e11.+ QUAD LIJS <br /> PoD . 3a 60 ;24 -57 TYPE 5 <br /> (Nailing Address ) FORMS 53 I.✓LV -2 <br /> NOTE" <br /> Shkz4 <; /-on LE4 9s� dG <br /> ( city , slate , zip Code ) . <br /> 2De� ¢ 66 — <br /> (Area Code Telephone Number) <br /> Sketch (Detailed plans may he submitted ) <br /> J C Gq //�R1GhC'q / /�' c� P J / <br /> 1�P �PS14V S0Ire L✓ , l / be � YO v / dL0 / YO " 5 h Gd SGC <br /> OP �(ccil05 /� IAe96/ 174w-AN VVA W 4 44el Rei Q PLaG �crHl� <br /> j706/ PS / Yl 4 k <br /> f'�rf� ec� �I % � w% eh /' • I <br /> The undersigned hereby applies for permission to excavate , const ct and/ or <br /> V side of <br /> otherwise encroach on County Highway Right - o £ - Way on the d ' f � ` <br /> j. approximately t+ ' <br /> of � b4 per orming ha <br /> z5 + E' <br /> followi;ig work ( description of work) Yd+ <br /> P) r -I , o Z70ye'h5 ML t� W �'! J' <BPre �. a'e/ <br /> Work will commence on or about <br /> 00 for approximately <br /> I Q days . <br /> S , the undersigned certify that T 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 /> accordance with the rules , regulations of San Joaquin County and subject to <br /> inspection and approval . <br /> M �� u <br /> signature of Applicant - Title D e <br /> N GTFR. ns\nEacR L <br />