Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date ' OFFICE USE ONLY <br /> To' San Joaquin CountJOB # 73-OSZ-Co REF # <br /> Department of Public Works APN CR # <br /> EXP. DATE "7 S-U-7 <br /> VALID• (b-(-o'l TO �l'15-07 DRIVEWAYS <br /> (Applicant Name) STREET ALPinNF RD. <br /> AREA 5rocl,;r6 QUAD /v� <br /> _A, V� TYPE `$E L L, }i o L'e 6-o'ee <br /> (Mailing Address) FORMS <br /> NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number)_ <br /> Sketch (Detailed plans may be submitted) TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> /, rr CURRENT M.U.T.C.D. <br /> Jr% CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to .excavate, con.s•truct and/or <br /> otherwise-encroach on County Highway Right-of-Wa:y-on-the side:of <br /> o�j &I approximately, feet/ 1 <br /> by per€arming the <br /> following work (description of. work) : ' ) <br /> Work will commence on or about for approximately <br /> t? � <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 described above in <br /> accordance with the rules, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> si ature of Applicant - Title <br /> W .PS\MMSCEML (6/00) <br /> i <br />