Laserfiche WebLink
Feb 27 04 CS; 21a Valued Custorner 205 458-8324 P. 1 <br /> AptLICATtcx FOR ENCROACMENT PERMIT <br /> PLEASE PRINT; <br /> Date c�it,�n 'a 2b0� OFYICS usg ONLY <br /> To; San Joaquin County JOB # PRr # <br /> Department of public Works APN C #��^ <br /> Z �Sr S EAE. DATE <br /> VA7,?'T-1 mp fiIV8W�Y8: <br /> ' II (Applicant N <br /> ame) STREeE <br /> �� �`i (�fi.1�✓� Sly ��� <br /> ARRA. ►C! <br /> TYFF p . LgAD 5� <br /> (Mailing Address) FOMS Z <br /> ESCC'.IUV-\. C1^/i %S 3DD NOSE <br /> (City, state, Zip Code) <br /> -63-6-���g <br /> (A ea Code - Telephone NLber) <br /> skctc:i (Detailed plans may be submitted; <br /> I <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on conn y Highway Right-of-Way on the 'E--%t. aide, of <br /> approximately L400-- 3(000 ee /mile O,ri-kn <br /> of C) i VVI Q.ti� <br /> fcllowing work (description of work) ; �j{fl.y ,� w ' by peYSorming the <br /> ff V�^Ohc ✓, <br /> V by Y�f _ <br /> Work will commence on or about, <br /> days. for approxi-mately <br /> I, the underSigned ce,tify that I an the owner of the respective property, or an <br /> qualified to represent the owner and agree to do the work 6eacribed abovo in <br /> accordance with the rules, regulations of San Joaquin Count), and subject to <br /> i-M-spection and approval.. <br /> —LOA- LL�� Post-if'Fax Note 767; <br /> Sig-at:ure of Applicant - Title b _ From <br /> KuTzA.Pa%7zU=I f6/001 cc.r a� Co. <br /> Ptcml k Pnore# <br /> Fax-t <br />