Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT <br /> Date / - _v OFFICE USE ONLY <br /> To: San Joaquin County JOB #� REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE 8-1<-07 S Ca�� �n�of, Z%�, VALID TO <br /> g3-jS-07 DRIVEWAYS <br /> (Applicant Name) STREET GT * <br /> AREA 'ice G� QUAD <br /> TYPE <br /> (Mailing Address) FORMS 'OAze <br /> J / NOTE <br /> (City, State, !Zip Code) <br /> 7c"y F3/ -6sly <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> l <br /> The undersigned hereby applies for permission to excavate. ronef-r„rf- —d/or <br /> otherwise encroach on County Highway Right-of-Way on the r4s1 5/-" side of <br /> el. approximately Z6c5 feet/mile S--fZ? <br /> of 0--r I , by performing the <br /> following work_ (description of work) : CJS ' �a� �<OU rs 77Sd2 <br /> �o �cd(/irss 77533 70 c-A7-L sr r r �s 2.7533 <br /> C/+ /f'� !'�G'l4 C/ '��sS L1 ✓rb� �.c� /�/� rrSTsrc f o � /O Cc�y77"/ <br /> Work will commence on or about -7- for approximately <br /> /C. days. <br /> I, the undersigned certify that I am the owner of the respective property, or am <br /> qualified to represeELt 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 /> 41 <br /> - e" <br /> 715� -0 J <br /> Sign re of Applicant - Title Date <br /> MIaS _PS\FEESCE{DL (6J00) <br />