Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date O OFFICE USE ONLY <br /> To: San Joaquin County <br /> JOB g 73oSL-� REF <br /> De rtment of Public Works fiPN CR' ff <br /> EXP_ DAT - 4 7 <br /> VALID 8 0{• DRIVEWAYS: <br /> (Applicant ARE <br /> Name) STREET <br /> A S1-J'PA/ QU �5 <br /> (/ TYPE LG H l <br /> Mailing Add-ess) FORMS <br /> NOTE <br /> (City, Sta. e, .Zip Code) , <br /> "' Area Code - Telephone Number) <br /> _ c . <br /> etc (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> UJ <br /> ccSHALL BE AS PER <br /> wCURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> UJ n <br /> g w <br /> l'l� i C ivn 1 a �b4�$C)q0 <br /> The undersigned hereby applies for permission to excavate, const r t and/or <br /> of rwise encroacho County Highway Right-of-Wa the side of <br /> approximatel feet/ ' e <br /> of b perfc i the <br /> fo lowi~ng wo k description of work) : <br /> -93 <br /> op <br /> Wo r will commence 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 with the rules, regulations of San Joaquin .County and subject to <br /> inspectionan approval_ <br /> L---- --- <br /> r_--,- t Tule PERIIQITSTO: Date <br /> raf,Y <br /> .Siyuatur2 vi Cai. - <br /> MASTER.PS',FEEsc-roi. (6/00) <br /> �Oe PFOCES8oM MSK- BW I <br /> 4M~LWW <br /> STOCKTON, CA 96204 <br />