Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT• <br /> Date /fir Gk OFFICE USE ONLY <br /> To: San Joaquin County JOB # 2Y,9)!`;' REF # <br /> Department of Public Works APN CR # <br /> �7-T � Y ��G'S�o'� <br /> EXP. DATE � <br /> VALID / J TO S1)i3 <br /> - DRIVEWAYS: <br /> (Applicant Name) STREET �rJSY <br /> AREA -- lrr,J <br /> TYPE 75=14 4E: �k'x� CdJJc-�E";ZF �r^e �1'G✓��- <br /> J (Mailing Address) FORMSr//,cl <br /> , 2 �C�<_-fC�'-J � �,�,�' j J ��� NOTE <br /> (City, State, Zip Code) <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> U°ti--�t C/ Jif CZ' <br /> f � <br /> ����� C�' � J N,z j oil✓✓ (7n ✓Q✓!:I dcl:j i(IN,�'� r✓�7 /i <br /> fir' <br /> The undersigned hereby applies for permission to excavates construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the , side -of <br /> ��l approximately /SO feet/m�e �UuOV <br /> of W<-, H')/y ';W. , by performing the <br /> following work (description of work) O7T f� � ,n C54./ 7��ife, /*/o {• ) Ciro ��« dor?F� <br /> U'F'r? ! oc. / ,/c c'�,v/}:� t "k"-i; Ip Vii.!' ;Tib %V (';Yj. L.r.. l..,%�!, ��? �;F / {y ��J'T�i✓�c <br /> 1V1 �/�•cCc j�Sc �ccl /•%+7,+5' f�.��C A/c;n <br /> Work will commence on or about -J-c R for approximately <br /> ZC 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 ruler, regulations of San Joaquin County and subject to <br /> inspection and approval. <br /> / z cl; <br /> Signati of Applicant - Title Date <br /> MAS^.ER.FS\FEES=L (6/00) <br />