Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date _ o OFFICE USE ONLY <br /> To: San Joaquin County JOB # REF # <br /> Department of Public Works APN _ CR' # <br /> / <br /> EXP. DATE 7-1-43 <br /> _ <br /> VALID TO 7-/-b'63 DRIVEWAYS: <br /> (Applicant: Name) STREETCIAW AP, <br /> AREA QUAD �— <br /> r TYPE fc)z_: <br /> (Mailing Address) FORMS '-*�� <br /> NOTE <br /> City, State, Zip✓Code) <br /> (Area _Code - Telephone-Number) . _.. _ <br /> Sketch (Detailed plans may be submitted) <br /> TRAFFIC CONTROL PLAN <br /> SHALL BE AS PER <br /> CURRENT M.U.T.C.D. <br /> CALIFORNIA SUPPLEMENT <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway. Right-of-Wa on-the 40( t4 side.-of <br /> . KAF6 4 0Dr approximately t feet/mi-Em- 9 / <br /> of C) L VC AVE" by:performing the <br /> fol owi work (description of work) : <br /> GE ri>K TMEM-CA—MICA-4c t r r <br /> Work will commence on or about ® for approximately <br /> D <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 /> inspe tion and approval. <br /> tot) <br /> Signature of Applicant - Title 'LO .Q J Date <br /> MASTER.PS\?nS®L (6/00) - <br />