Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date <br /> L�J J 6, OFFICE USE ONLY <br /> To: San Joaquin County JOB # ����5 REF # — <br /> Department of Public Works APN I OS -I to CR # R' ' 1p4fa4'Q3 <br /> EXP. DATE 0� <br /> hA C. VAI Qn VALID 4 l 1 18-► TO l O DRIVEWAYS: <br /> (Applica t Name) STREET lRe R-Oa <br /> AREA QUAD �I E <br /> P iytr- b r s udy, A TYPE 56 V\ <br /> (Mailing Address)s FORMS C 5 /W W <br /> NOTE <br /> sock vn , CA 615d. ,q <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> see, L-446AM plans <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the W-1iSside of <br /> approximately feet/mile Noof EIJISnor" <br /> 4ZOGa byperforming the <br /> followink ( escription of work) : 24 <br /> Work will commence on or about 7lti�LQ. I �a`LOD"j for approximately <br /> �YWr►4hs . <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 approval . <br /> /Z . - <br /> Signa a of Applicant - Title Date <br /> MASTER.PS\PEESCHDL (6/00) <br />