Laserfiche WebLink
I IUJ u V V J . JJp V p 1 UC V V U71.U111 C'( GIJJ TOC-JJGT O <br /> APPLICATION FOR ENCROACMd:EX*I PEP <br /> PLEhBE pRrN'r; <br /> Date <br /> OFFICE <br /> To: San Joaquin CountyUSS ONLY <br /> nepartmentl .TOR #— � (� <br /> of.puhZ.ic Works REF # <br /> /APEX' E?.IV ATEC APN CK # 1 <br /> NEXP. DATE O <br /> (applicant Name) - VALID d TO <br /> I Zcf STREET DRIVgplAYB <br /> �IR�TES V1(�}►� AREA + <br /> QUAD t <br /> (btailiag Addro88) — TYPR <br /> SRAM�T/Tp /•� FORMS <br /> Cl15670 <br /> 9 5670 NOTE <br /> (City. at'", Zig Coda) <br /> (Aroa Code - 2ele <br /> phone Number) <br /> Sketch (DetailAd plana may be su•bmi-tted) <br /> The undersigned hereby applies for - <br /> otherwise encroach n Count. Permission to:exc,avate, c ns•truct and/or <br /> IX STgeer' 0 �A�1„�q }' Highway Right-of •the <br /> of app�oximatelyE71 O_2 side of <br /> followin work TlQ►t OF t aceto F St prlTA fee /mile �oRT�-} <br /> �g (description of work) . I 0 f�(nJ6 b <br /> HoU�fl R by 'pezforming the <br /> 4F 5iIF <br /> x ST' —tQ cµ��6 �So X66 £ WeLLs <br /> ^1C C.�oS 0 U6 <br /> ark wilt commence on or about <br /> days• 2no�1- for a <br /> PProximataly <br /> I. the undersi <br /> gned 'cartify that <br /> qualified to I am the owner of the respective <br /> represent the owner and .agree accord�cg with the regulationscrd <br /> gree to do the work de, <br /> ihproperty, <br /> in am <br /> inspection anal appro al , re3 <br /> ations of San Joaquin Count <br /> Y and subject to <br /> Signature of Applicant _ Title <br /> SRA.D6\PS�SOIDL ls�oo� Date <br />