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< r iir Luu;.7 14.1L LU']4 OOJJL4 SJI,u r'tKml 15 r,�)VE U2 112 <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PL)EASI_PP NT: <br /> Date -_-- 03/(q (a(O OFFICE USa ONLY <br /> To: San JoAquin County FVALI�D _ <br /> r REF # <br /> Depaztmcnt of pgblic Works CR' # <br /> KetaSo,, S /5 o4=fl�F To DRIVEWAYS: <br /> (Appli.Cant NaMa) <br /> TYPE R <br /> (Mailing Addrama) FORMS W - <br /> So.G(an1kh4 A 9S8Z NOTE <br /> i <br /> (City, state, Zip Code) <br /> (916 ) 5-79 -32LC� <br /> (Area Coda - Telephone Mumbe7r) <br /> FAX : (W6) ?7 9 -3-7'�S- <br /> Sketch, (Detailed plane may be submitted) <br /> M v <br /> sa z <br /> 0 ox <br /> -v C) <br /> C C::_ <br /> co +�T— <br /> C7 'nom <br /> o� <br /> 0 <br /> f <br /> The undersigned hereby applies for permission to excavate, const?}�ct and/or <br /> otherwise encroach on County Highway Right-of-way on the So—+t side of <br /> w. 13 rah 9,&,d approximately 300 <br /> .} L r�e K by pextorming the <br /> gol.lowing work (description of wozlc) : Z-�5 !'� 2v Svr' �0-n�5 1- eaSew\.c' <br /> (Qc_{"h.C'•h roac) p...,� er��? 'F� �.. °v-'a'1 . SEE Aire'C•iY6 <br /> Work will commence on or about 4 S a( 6 for approximately <br /> 7 days. <br /> I, the undersigned certify that I 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 end subject to <br /> inspection and approval. + <br /> Signataxa of Applicant. - Title Date <br /> HA`<SN0..PB\RRrtRLIIDL 16(001 . <br /> Post-lta Fax Note 7671 bola/44va<T13 'a�aos 2 <br /> from c <br /> Co./Depl. Jd Co 5 : r/ <br /> Phono. Phone rr � <br /> 1 <br /> \I\ <br />