Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date (J' 3�0� OFFICE USE ONLY <br /> To: San Joaquin County JOB # ;2X6?-( REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE <br /> VALID Z O / D DRIVEWAYS: <br /> (Applicant Name) STREET WNAMS <br /> J%#ftWVV ���OG AREA �� QUAD_4200 <br /> TYPE LG BOLE e-IAI Xyl <br /> (Mailing Address) FORMS 7�S/ f ,CrO <br /> NOTE <br /> (City, State, Zip Code) <br /> bA !A�z 1&, <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER n <br /> CURRENT M.U.T.C.D. -4 CM <br /> C <br /> b <br /> CALIFORNIA SUPPLEMENT <br /> z m <br /> m co _� <br /> 0 a 7r+c <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the ai* side of <br /> ktni==2 Ned approximately 2�— feet/rm;i; <br /> of t2m 4_�s '�� by perfor ing the <br /> follow'ng work (description o work) <br /> JWL6 6S v L' <br /> Work will commence on or about for approximately <br /> Ito 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 /> van of 19f 6? r <br /> Si ature of Applicant - Title Date <br /> MAST ..P \FEESCOL (6/00) ��$_ TO: <br /> yyi�pp ��pp��yy11�� • �//���Q�yy pp�� � <br /> 1/VO rrM/G� DEW• BW 1 <br /> STO . CA <br />