Laserfiche WebLink
U,./ L-/ GUC^ ..,,...._ 4 JJt.rJ r-Cmin.L IJ <br /> mut n ri ots <br /> APPLICATION FOR ENCROAMONT PERMIT <br /> P-LEASE PtRINT: <br /> Date . V UL! �=f g OFFICE USs ONLY <br /> To: San Joaquin county J_O_B.•0 76DJ��G REr # <br /> Department of Public works APN CX # <br /> G O Stx l o„ /YIvN�4 /y 1 EXP. DATE <br /> y Pte! �Jf l�keS /JPP`• VALID TO DRIVXNATS.. <br /> (Applicant Name) STREET <br /> Z SDD �`-� �r i v� eN AREA A_ <br /> -- <br /> (Mailing Address) FORMS '6i/sv777-7- <br /> 1104S NOTE <br /> SfocAtom, CA gs2,06- 101 <br /> (city, state, Zip -code) <br /> q 3 - g ?5-0 <br /> (Area Code Telephone Number) <br /> Sketch (Detailed plans may be submitted) <br /> Map �.��4�4� , �e fa;k� &q <br /> �w t f be <br /> The undersigned hereby applies for permission to excavate, construct and/or <br /> otherwise encroach on County Highway Right-of-Way on the side of <br /> approximately feet/mile. <br /> of , by <br /> e rM14 <br /> following worrk (description of work) : Tes �&// , $bo ,4tt 6 5-11 swh4v.-}tel <br /> _D_%QG awG 7-9 3 5-tv I-eet o� ��``J yZ " � 36 '` Tra�fa �.. <br /> Work will commence on or about for approximately <br /> 7i �A?Sfrc.vft•�+ taS..� <br /> I, the/u dersigned 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 /> � d <br /> ign3ture of Appli t /Tit a <br /> lNGaq-� ��f 114"r7�h`' <br /> w�sZlt.ra%YBR9Cfmt (c/oo) �( <br />