Laserfiche WebLink
P L Ir APIWCA 'ION FOR ENCROAC 1ENTPI; OUT <br /> Date OFFICE USI, ONLY <br /> FJOBY /D D J REF/l <br /> To: San Joaquin County Ilighwzj artmeCRVa <br /> y Dep . E <br /> V:1LID Z TO DRIV�tiYAYS: <br /> �isir Tic At* STREET <br /> (:1pplicant Name) AREA 57-0 •v G✓ ,� s <br /> ti QUAD�_ s . <br /> TYPE Ave, : <br /> (INL'Wing Address) FORMS s <br /> NOTE To <br /> z � <br /> 7 <br /> (City, Statd Zip Code) <br /> �n19 - yBS - Stoo _ <br /> (Arca Code-Telephone Number) <br /> Sketch(Defailedplans may w$ubrIIlt:.+Ad) <br /> lk <br /> SD 5-uJA <br /> --------.__ � ._ �V V►�.S__D of V V A y �'�'— <br /> WORK _{ `f-- +'/J(W — — — <br /> AREA <br /> : - ---- - <br /> The undersigned hereby applies forpennission to e:;cavate, construct and!or othemise encroach on Coun <br /> F--ighW8_Y Richt-of-Way on the „s-r side of V✓► b o N �n/A y ty <br /> 0 O eet ! So�-r�t of 5 A csv AJ -r-r L,A,.! aPProxiII�utely <br /> following woric: (description of wont j. , by Performing <br /> Work wM commence on or a'oout -7 Z Z /q <br /> for appro:timatcly 0 day$. <br /> I the undersigned cerdf.�that I am the ow*�er of iha res**ective pro <br /> agree to Jo tho tivoer <br /> rk Jcscnbcii above in accorJlncc Nvi111 ttic rules, regulations r am oteJoaquin d to rCounty snesent the �sut <br /> to inspcctio proval. <br /> /'4,KE SAv2E <br /> Si ' ATLRE OF APPLICfANT - TTI'LE <br /> DATE <br />