Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date JAN 2 2007 OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APNCR # <br /> EXP. DATE � 30 7 <br /> { fir E . VALID. I-J- 2 TO IQDRIVEWAYS: <br /> (A%pp]icant Name) STREET STAMAI AWMW <br /> AREA ,gztac,eTON QUAD NS <br /> TYPE 8EJ-L Hoye <br /> (Mailing Address) FORMS 5s�lyw 12-29 <br /> c� �11 J�� NOTE <br /> (City, Sta_lte, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to.excavate, .cons•true and/or <br /> otherwise- encroach on County Highway Right-of-Way-on-the side,.-of <br /> -54 <br /> papproximatel feet, ��� <br /> of ` L MEZM L_ � p by "per€orming the <br /> fo lowin work (description of work) : <br /> " 9F 0 ue E <br /> - <br /> Work will commence on or aboutZC 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 /> inspection and appr val. <br /> �D �04 9n� "'O 'ldAN 2 2007 <br /> Signature of Appi cant Title 8 :) Wd S- NFLOUL Data <br /> M2LSTRR.PS\FRRSCHDL (6/00) <br /> 03 AJ 101 <br /> i <br />