Laserfiche WebLink
APPLICATION FOR ENCROACI[MENT PERMIT <br /> PLEASE PRINT: SAN JOAQUIN (: UNTY <br /> f <br /> Date I` 1920W M6 PM 1- 36 OFFICE USE ONLY <br /> DEPT. OF PU3LI% WORKS <br /> To: San Joaquin County JOB # MaZ REF # <br /> Department of Public Works� APN CR # <br /> EXP. DATE S�O <br /> " 6/) VALIDTO /3 O!o DRIVEWAYS: <br /> (Applicant Name) STREET <br /> 'I p AREA QUAD AI <br /> d 03 ! �ao7'L`t-ILL S / 4ad s r-e. 1 on TYPE IJ� �,eOl3T� <br /> (Nailing Address) FORMS 4'� /� <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number). <br /> Frec1. Hu3, <br /> Sketch (Detailed plans may be sub�mitted)'^ <br /> L'_)o R,� A'f�l� �' Los`` g R, e,e Zvi `� •�� `f <br /> The undersigned hereby applies for permission to .excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the side..of, <br /> approximately feet/mile <br /> of by_"per€ormi g the <br /> following work ( escript' of.wor ) : -e- <br /> Work will commen on or'about o iV for approximately <br /> ° u� � ya`•�"Sp� <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 and subject to <br /> inspection and approval. <br /> 1'� A M�L <br /> Signature of Applicant =Title Date <br /> MUTER.PS\pgSSCBDL (6/00) / •��/ '� `/"�` /� ., <br /> I <br />