Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> RE CL <br /> PLEASE PRINT: SAN JOAUUIf� couJ jTY <br /> Date 7 oFFIC$ II ' 3 1 <br /> Jf�vc DEPT. OF PUBLiC WORKS <br /> To: San Joaquin County JOB # REF # <br /> Department <br /> �o�ff Public Works APN CR # <br /> ' d c�6� `'Q _ j� a VAL EXP. DATE <br /> (�CT� � VALIDTO DRIV$OPAYS <br /> (Applicant Name) STREET %2 Ow <br /> jbwAREA ST�T6� QUAD <br /> - - —(�* TYPE / W. f S <br /> (Mailing Addrew) FORMS s OW, oe-Z4 <br /> NOTE <br /> (City, State, .Zip Code) <br /> (Area Code - Telephone Number)_ <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to .excavate, const ct and/or <br /> otherwise-encroach on County Highway Right-of-Way.on-the <br /> See ,� approximately feet/mile <br /> of _- - by "-performing the <br /> following work (description of:work) : <br /> Gtf <br /> Wor "" Nn ence on or'about for approximately <br /> 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 th the rules, regulations 'of San Joaquin County and subject to <br /> inspec io d appro a <br /> 17/V"4� <br /> Sgna re o ant Title Darts <br /> MASTER.pS\FSEs (6/00) - - <br /> i <br />