Laserfiche WebLink
--UUJJL4 SJUU I`EH iIS PAGE 01,G-ii <br /> APPLICATION FOR EN'CROACW0NT PARMIT <br /> PLEA P-- RIN � <br /> Date Locz <br /> OFFICE. USE ONLY <br /> To: ,San J'oaquinTTTcovnty JOB 4 �� _ REF 4 <br /> Department of Public Works APN <br /> L tt //�� Exp. DATE 5-ZI-0-7 <br /> FU Ifs i ./i soc . VALID 1-4:)7' TO <-. 2,1-0"7 DRIVEWAYS: <br /> (Applicant Name) <br /> 3'-11-0- <br /> ARS <br /> 3 �uAn �vtJ <br /> '-1 10- �(• f"4a�-+c✓ l ko%m TYPE <br /> (Mailing Address) FORMS <br /> 5-60"Ov `Ar 95:3_ip l 'NOTE <br /> (City, Sbate"Zip Code) <br /> (Aog) a34 <br /> (Area Code - .Telephone Number) <br /> Sketch (Detailed plans may be subntiitted) <br /> Tb.e undersigned hereby, applies for. p©miosion to .eraavate, conotrct and/or <br /> otherwise- encroach on..County..Highway Right-of-Way oa the W�r.� std of . <br /> l.o SGGvaMe440 approximately490* �LOOO ee mile r�/'"Tl� <br /> of by per r <br /> €ominq the <br /> following work (dkiscription of. worst} <br /> Wor3- will commence on or 'about for approximateiy <br /> �a�P <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 descxi.bed above in <br /> accordance with the rules, regvlaticns of San Joaquin County and subject to <br /> inspection and approval.. <br /> gnature of Applicant - tle <br /> Efate <br /> MAGT'6P-Dg\B7+RGCFJ7)T. {r,/00) - - <br />