Laserfiche WebLink
APPLICATION FOR ENCROACIMENT PERMIT <br /> PLEASE PRINT: <br /> OFFICE USE ONLY <br /> Date <br /> 7��Z-� REF <br /> To: San Joaquin County APN REF # <br /> # CR' # <br /> Department of Public Works <br /> - 1-ai <br /> EXP. DATE / <br /> DRIVE4AYS <br /> VALID TO /�1-o <br /> * <br /> (Applicant Name) STREET n1>,. ,Lai Rol, <br /> AREA cam/-oc%f c,» QUAD N <br /> TYPE * <br /> (Mailing Address) FORMS Lou <br /> NOTE <br /> STD G��►..�, C.IJ- � �Zo <br /> (City, State, Zip Code) <br /> 19 4Z - t X37 <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN" <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> RETURN MWITS TO. CALIFORNIA SUPPLEMENT <br /> pe" <br /> ,SOB PROCESliM DESK- BLD 1 <br /> 4040~Land <br /> STOCKTON, CA 9620-4 -7- <br /> 7-TheThe <br /> undersigned hereby applies for permission to .excavate, construct and/or <br /> otherwise-encroach on County Highway Right-of-Way onthe EAST• side_of <br /> approximately 30�J set mile <br /> of STEY C� .) G c�c�C-���r�- - Y Per€ormirig the <br /> following work (description of work) : 5 L- <br /> - sem.is�a: 4cz:)\G. <br /> Work will commence on or about for approximately <br /> Z 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 described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval.. <br /> E <br /> S'gnature of Applicant - Title Date <br /> MASTER.PS\PEES®L (6/00) <br /> I <br />