Laserfiche WebLink
APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date <br /> FNOTEV <br /> FFICE USE ONLY <br /> To : San Joaquin County �g_ 3 REF ## <br /> Department of Public Works CR # <br /> EXP. E -is-OQ1TO -1 ---0- DRIVEWAYS: <br /> (Applicant Name) jSyap,J /lp 1CTG�t QUADv(Mailing Address) <br /> (City, State, Zip Code) <br /> 0.1os -- ge13- c/-7/ ? <br /> (Area Code - Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> The undersigned hereby applies for permission to excavate; construct and/or <br /> otherwise encr ach on County Highway Right-of-Way on the G-- <br /> SS/O� �.' side of <br /> �---7-� approximately / Z ee /mile <br /> of �k�J S'7'�L f-f'�1� e <br /> following work (description of work) : by per orming t e <br /> G Gorrc <br /> Work will commence on or about _�(�/VC ©_ pt <br /> rte, days. for approximately <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 /> cam- �►'` - ��--0?7 X00 <br /> Signature of Applicant - Title <br /> Date <br /> MAS RR.FS`.FEESCFuL (6/-0) <br />