Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date A <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB REF # <br /> Department of Public Works APN CR ## <br /> �L <br /> EXP. DATE <br /> (`+ VALID _ � TO / DRIVEWAYS: <br /> (Applicant N,/a��me//��)�� L STREET >►7/,�i[LOj�,c <br /> 4,JYA)�.�F�ST AREA r—• �..--l+�r�r��QUAD 2—, <br /> TYPE <br /> (Mailing Address) _may FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code Telephone Number) „ <br /> V ' <br /> Sketch (Detailed plans may be submitted) <br /> Ln TRAFFIC CONTROL PLAN <br /> c. SHALL BE A5 PER <br /> CURRENT M.U.T.C.D. <br /> t <.a CALIFORNIA SUPPLEMENT <br /> • = _, <br /> ro <br /> 00 <br /> yal <br /> The undersigned hereby applies for permission to excavate; onstruct and/or <br /> otherwise encroach on County Highway Right-of-Way 'on the side of <br /> 0s2Capproximately feet maw' <br /> of / <br /> by performing the <br /> following work description of work) : <br /> #Q-4. <br /> Work will commence on or about •!lX.� ; <br /> days. for-approximately'' <br /> � . � , <br /> I, the undersigned certify that I am the owner of the re8pective property, •.or am <br /> qualified to represent the owner and agree to do �h''e' work' d'e,2cribdd+a1#,!2V%4jV <br /> accordance with the rules, regulations of San- Toaq_a4&)"',CQ nty,and subje o " <br /> inspection and approval. <br /> =� •� �r` ...„ ,x ;, <br /> Si ature of Applicant - Title RE <br /> Dat�e <br /> M � <br /> AST •P \FEESOML (6/00) RETU 7 P'RMMS TO: <br /> PftE <br /> PRMES8*M DESK- SW 1 <br /> U <br /> STOCKMN, CA <br />