Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date /")/-/ /�/0 OFFICE USE ONLY <br /> To: San Joaquin County JOB # //00 S REF # — <br /> Department of Public Works APN /V/A CR # — <br /> EXP. DATE 14 to Z <br /> A�A^ C-) re-n S VALID 4 12 Z_ TO z4,La7 DRIVEWAYS: <br /> (Applicant Name) STREET ,ennev) A917'• * — <br /> �-7 AREA C SC'?1/® QUAD �— <br /> _ TYPE , zTl O/asure L ¢&' <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, Zip Code) -- <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) � <br /> r <br /> 'P#, ,C Gia,�� y G: <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on theide of <br /> approximately feet/mile <br /> of by performing the <br /> following work (description of work) : <br /> /li2c�r'1 i G /Oc.ci -1 GwC <br /> wk__ 7 <br /> work will commence on or about /3 — for approximately <br /> �L f Cna. Lr ays. <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 /> i;atiL <br /> ectin and approval/55' <br /> licant - Title Date <br /> MASTER.PS\PEESCHDL (6/00) <br />