Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date ^� 07-- OFFICE USE ONLY <br /> To: San Joaquin County JOB # Ifd DREF # <br /> Department of Public Works APN CR # <br /> EXP. DATE 4-41107 <br /> VALID v v7 TO $ / D7 DRIVEWAYS <br /> (Applicant Name) STREET A�lit/.hL/FlJ� AYE. <br /> � � � AREA `✓-'f�k-%#A,� QUAD WS <br /> fes--='/(G(C_�/lr TYPE ?CENc H <br /> (Mailing Address) FORMS sT, -ZS <br /> NOTE <br /> 1, (City, State, Z:ip�Code) <br /> ( rea Code - Telephone Number) <br /> Sketch Detailed plans) may be submitted) I Z �N {}yY�t�i 'r0 r � <br /> ---�� v Ta v12 <br /> mozj:;�LD <br /> . I <br /> JJA C <br /> C,%-rl St W=k V11 LiJC <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the T side of <br /> D1l.�,C/�Gkproximately U ee /mile fi(�L�jT <br /> of It�///(- SYoc/CYowO by performing the <br /> following work (description of work) : C4 I/VfnnJl,, <br /> Work will commence on or about fJSl�d C� for approximately <br /> days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represent tY.:e 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 /> Si ature of Applicant - Title Date <br /> MASTER.PS\FEESCHDL (6/00) <br />