Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> v O� 20P6 APS 28 AM if: Pq <br /> Date OFFIC F ONLY <br /> F or ;,, ill 1" WC)RKS <br /> To: San Joaquin County JOB # <br /> Department of Public Works APN CR # <br /> EXP. DATE O!O <br /> VALID TO ot. DRIVEWAYS: <br /> (Applicant Name) STREET9 bo j <br /> /,�( / AREA �T�'AI QUAD. <br /> �'7 � L.n TYPE 59SE;�2-1 ,46eE $D,$G <br /> (M-ailing Address) 04 FORMS will ! <br /> NOTE <br /> ■ <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) + <br /> Sketch (Detailed plans may be submitted) j <br /> TRAITiC CONTROL P"Nt „ <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. . <br /> CALIFORNIA SUPPLEMENT <br /> ALS' <br /> The undersigned hereby applies for permission to excavate, cons ruct and/or <br /> otqArwise encroach on County Highway Right-of-Wa on the side <br /> rnib A.Vt approximatel feet/ <br /> of ; b performing the <br /> followin wor (description of work) : <br /> n ). <br /> Work w'll commence on or about -p' for approxi.mateby ,v <br /> L 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 with the rules,. regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> Cay r —o <br /> raturef Applicant - Title RET �te <br /> (6/00) - - ---�&C PERWS •O• <br /> • � <br /> .IOB PROMS DESK- BLD 1 <br /> 4040 Wed LWW <br /> STOCKTON,CA 95204 <br />