Laserfiche WebLink
08!21/2007 12: 09 2094689324 SJCO PERMITS <br /> PAGE 01IO2 <br /> APPT KATION FOR ENCROACHMENT PERMIT <br /> PLE&,SE PRINT <br /> Date .2( A"�'li.sf OVYICZ USE ONLY <br /> To: Sari Joaquin County JOB # //Db_ _ REF # <br /> Department of public Works <br /> ,1 11 EXP. DATE 2/o7 <br /> L.��L Skc-�•om_I tv n�[U �n15 w1T�4Ts VALLA TO a <br /> (Applicant Name) � STREET <br /> COS$ �( AMBA Cs� QUAD 5K/ <br /> �-}rtG�� J at`�-t �UU TYPE oe <br /> (Mailing Addrang) FORMS SS[rwc,, <br /> CA 12 DOTE ._ <br /> (C�ty, State, Zip Code) <br /> SID -- <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Plu,sG :�,eC c.l["eco +"&r <br /> LG u,4 1 ui A4,,lp <br /> The undersigned hereby applies 'for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Ri.gb,t-of-way on, the We, side of <br /> y ROL.r,� approximately 1. Uk flet/mile <br /> of rL by 'pe�£orming the <br /> follow ng work (description. of work) : <br /> r_QV,Nt 1v <br /> A-(' <br /> A, <br /> Work will commence on, or about 10 $,ee*�esKbe. for approximately <br /> SGI��t days r 2�.tl7 ppxoac�mat©1 <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 withZia <br /> l regulations of ,San Joaquin County and subject to <br /> ,inspecL,ton and l. <br /> ., <br /> Signature o P - Title Date <br /> MABTER.Pe.\PP29CHDL t6/001 <br />