Laserfiche WebLink
FROM :CAL I FORK I A WATER SERO I CE FAX NO. :209464019'5 Jar. 14 '22UHH_ <br /> AppLTbAT3:0N FOR ENCROACEbMT PERMT <br /> pr,�ASg PRINT s_ 1 5.1 <br /> Date " - � — O8'8'zC =X ONLY <br /> TO: San aoaqu3.a County araB ' RW # <br /> Department of public Works APP = ' # <br /> EYP. DATE A'c <br /> r�5 c� xo 3?RIY31WAYS: <br /> C� \• (App JC$zflt Lxams) ST MT <br /> (Xai:LAzg Addroeaa) FOM48 <br /> (City,. state, -Zip Code) <br /> (Area (:ode - Telephone Number), <br /> Sketch (Detailed plam.a may be admitted) <br /> The undersigned hereby,applies for pezTji.ssion to.excavate, const=ct =d,/or <br /> otbA=ASe-eacroach-on eauaby�Highway rhe ,\N.__Mr.R, aidt,.af••• <br /> t zs' s RMAC _X__% R\J V_• approximately <br /> of W RS1 N Cs�C`b�1 S hY'pexormirig the <br /> a. <br /> following work deac>ription of work <br /> Work will commeuce on vr'about for approximately <br /> clays. ,• w <br /> I, the uuderaigned certify that l am the owner of the re <br /> epeotive property, as am <br /> qual�.fled to represent the owner and agree to do rhe wank descrj)►e above in <br /> accordance with the rut , a:egtalaions'o£ Saar %Toaquin. County arra sub j ett to <br /> inspection and approva.lkpa 11"cj i <br /> IMA���AS IOU 11 1. 2a <br /> Signat=6 of Applicamt - Title Date <br />