Laserfiche WebLink
--PI__IM :1_HL I FURt J I P LAPTER 'SERI.!I CE FH: I�UJ. :_2094640195 Tun. 24 20n0_; 04:=t4PM P <br /> APPLICATION FOR ENCR.OACEMNT PERMIT <br /> kLEAS E PRIR'T <br /> Date a` S OFFICE USE ONLY <br /> To: San Joaga3_-1 County JOS REF <br /> Department of Public Works # <br /> APN ._... -.- <br /> i1� L.d`., �Jtip�q..y V1�LLIA DATE <br /> TO <br /> /QB _. � xvEwz�Ys <br /> {Applicant Naze) STREET &1ka4w <br /> mmA 62 <br /> (Xa.iling Addroas) FORMS <br /> NOTE <br /> (City, State, .Zip Code) <br /> (.Area Code - Telephone Number). - <br /> Sketch (Detailead plazas mAy be submitted) <br /> W.\ 1\� <br /> The under-signed hereby applies for permission to,excavate, construct anal/ox <br /> otherwiiae­encroach•ozl County.Highway Right-of-Way•o`x-the ti aids,ref <br /> 4F��it�4Q S"C` approximately y C1� fee _ <br /> of .S RNCT1a1 N STT-t L M + �• ''�. by performing the <br /> following work (description of,work ~ <br /> 'Rti'PLACE V, S i1C'�•01+15 <br /> Si` � ..1 <br /> Work will commence on or'about Qlo- a Ona for approximately <br /> days <br /> 1, the ' nde'rsigned certify, that X am the Owner' of, there specti.ve ,property, or am <br /> qualified to represent the owner and agree to do the work described above in <br /> accordance with the ru] reguS <br /> , xzs <br /> at 'of San Joaguz n County and subject toinspection and approvaid$-Ia:'M) <br /> Signature of Applicaazt Title Date <br /> K1C7C1SR.y8\R7f6C8DU fG/09} ,•`' <br /> t <br /> - t <br />