Laserfiche WebLink
e <br /> APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date JAN 1 3 2Q07 OFFICE USE ONLY <br /> To: San Joaquin County JOB # -734 5-L- (o REF # <br /> Department of Public Works APN CR' # <br /> EXP. DATE <br /> i VALID TO DRIVEWAYS: <br /> (App icant Name) STREET <br /> AREA ---q'oc.lSTizC/ QUAD <br /> TYPE 1XCwN SELF froCf. *© <br /> (Mailing Address) FORMS 5�, L- -, <br /> NOTE -3. <br /> y� <br /> (City, Sta e, Zip Code) --J <br /> (Area Code - Telephone Number) <br /> 74 N <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PEP <br /> / CURRENT M.U.T.C.D. <br /> G CALIFORNIA SUPPLEMENT <br /> I <br /> �--- <br /> b o ZZ — X, dZ L <br /> The undersigned hereby applies for permission to excavate, c ns.truct and/or <br /> otherw' e- encroacli on County Highway Right-of-Way-on-the D side..of <br /> EF It/� _ approximat Iy feet/vOW <br /> of D by^mer€ozmiri the <br /> following work desc.ri on of or L_(.. c�C.= \/ <br /> C)F 6 N C <br /> Work will commence on or about GYM 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 /> in c ion and approval. y <br /> C) JA N 1 3 2007 <br /> Signature of App icant - Title Date <br /> MASTSR.PS\FRESCSDL (6/00) <br /> I <br />